Gross Norma T, Arias M L, Moraga M, Baddasarow Y, Jarstrand C
Centro de Investigaciones en Enfermedades Tropicales (CIET), Facultad de Microbiologia, Universidad de Costa Rica, San José 2060, Costa Rica.
Infect Dis Obstet Gynecol. 2007;2007:82412. doi: 10.1155/2007/82412.
We investigated the use of miconazole among female prostitutes in Costa Rica as well as the distribution of vaginal yeasts and the susceptibility pattern to azoles of strains obtained from this population. Our intention was to relate a frequent use of miconazole to occurrence of vaginal yeasts resistant to azoles.
Vaginal samples were taken from 277 patients that have previously used azoles. Vaginal swabs were obtained for direct microscopy and culture. Yeast isolates were identified by germ tube test and assimilation pattern. Susceptibility testing was determined using a tablet diffusion method.
The number of clinical Candida isolates (one from each patient) was 57 (20.6%). C. albicans was the predominant species (70%), followed by C. parapsilosis (12%), C. tropicalis (5.3%), C. glabrata and C. famata (3.5% each), C. krusei, C. inconspicua and C. guilliermondii (1.7% each). The majority of vaginal Candida isolates were susceptible to ketoconazole (91%), fluconazole (96.5%), and itraconazole (98%). A lower susceptibility of some isolates to miconazole (63%) was observed as compared to the other azoles tested. Moreover, the strains, nonsusceptible to miconazole, were more often obtained from patients that have used this antifungal at least four times within the last year before taking the samples as compared to those with three or less treatments (P<.01).
An indiscriminate use of miconazole, such as that observed among female prostitutes in Costa Rica, results in a reduced susceptibility of vaginal yeasts to miconazole but not to other azoles.
我们调查了在哥斯达黎加女性性工作者中咪康唑的使用情况,以及阴道酵母菌的分布和从该人群分离出的菌株对唑类药物的药敏模式。我们旨在探讨频繁使用咪康唑与对唑类耐药的阴道酵母菌的发生之间的关系。
从277名曾使用过唑类药物的患者中采集阴道样本。获取阴道拭子用于直接显微镜检查和培养。通过芽管试验和同化模式鉴定酵母菌分离株。使用纸片扩散法进行药敏试验。
临床念珠菌分离株(每位患者一株)的数量为57株(20.6%)。白色念珠菌是主要菌种(70%),其次是近平滑念珠菌(12%)、热带念珠菌(5.3%)、光滑念珠菌和季也蒙念珠菌(各3.5%)、克柔念珠菌、 inconspicua念珠菌和吉列蒙念珠菌(各1.7%)。大多数阴道念珠菌分离株对酮康唑(91%)、氟康唑(96.5%)和伊曲康唑(98%)敏感。与其他测试的唑类药物相比,观察到一些分离株对咪康唑的敏感性较低(63%)。此外,与接受过三次或更少治疗的患者相比,对咪康唑不敏感的菌株更常从在采样前一年内至少使用过四次这种抗真菌药物的患者中分离得到(P<0.01)。
如在哥斯达黎加女性性工作者中观察到的那样,不加区别地使用咪康唑会导致阴道酵母菌对咪康唑的敏感性降低,但对其他唑类药物无此影响。