Rautemaa Riina, Richardson Malcolm, Pfaller Michael, Perheentupa Jaakko, Saxen Harri
Department of Microbiology and Immunology, Haartman Institute, University of Helsinki, Finland.
Scand J Infect Dis. 2008;40(11-12):904-7. doi: 10.1080/00365540802275853.
We have analysed further the y of usage of antifungals in autoimmune polyendocrinopathy - candidiasis - ectodermal dystrophy (APECED) patients and its impact on the susceptibility to fluconazole in Candida albicans. Data were obtained from patient records up to 30 y earlier. Analysing the use of azoles preceding isolation of each isolate showed that significantly more y of azole usage preceded isolation of C. albicans with decreased susceptibility to fluconazole than isolation of susceptible isolates. This was found to be mainly due to the usage of azoles other than fluconazole. Significantly more y of usage of ketoconazole and miconazole preceded the isolation of strains with decreased susceptibility to fluconazole than susceptible isolates (p=0.0241 and 0.0012, respectively). These results highlight that also topical compounds, in particular miconazole, may influence fluconazole susceptibility. Our data indicate that discretion should be used in the long-term use of all azoles, including topical miconazole. At the same time topical amphotericin B appears to be a safe choice as resistance is very rare despite y of usage.
我们进一步分析了自身免疫性多内分泌腺病-念珠菌病-外胚层营养不良（APECED）患者抗真菌药物的使用年限及其对白色念珠菌氟康唑敏感性的影响。数据来自30年前的患者记录。分析每种分离株分离前唑类药物的使用情况表明，与敏感分离株相比，分离出对氟康唑敏感性降低的白色念珠菌之前，唑类药物的使用年限显著更长。发现这主要是由于使用了氟康唑以外的唑类药物。与敏感分离株相比，分离出对氟康唑敏感性降低的菌株之前，酮康唑和咪康唑的使用年限显著更长（分别为p=0.0241和0.0012）。这些结果突出表明，局部用化合物，特别是咪康唑，也可能影响氟康唑的敏感性。我们的数据表明，在长期使用所有唑类药物（包括局部用咪康唑）时应谨慎。同时，局部用两性霉素B似乎是一个安全的选择，因为尽管使用年限长，但耐药性非常罕见。
