烟曲霉唑类抗药性：2008 年和 2009 年。
Azole antifungal resistance in Aspergillus fumigatus: 2008 and 2009.
机构信息
The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
出版信息
J Antimicrob Chemother. 2010 Oct;65(10):2116-8. doi: 10.1093/jac/dkq279. Epub 2010 Aug 20.
OBJECTIVES
Resistance to azole antifungal drugs in Aspergillus fumigatus is now a major clinical problem in some locations. Here we update our previous experience with data from 2008-09.
METHODS
We tested all A. fumigatus isolates submitted to the Mycology Reference Centre Manchester in 2008 and 2009 for susceptibility to itraconazole, voriconazole and posaconazole. We undertook CYP51A sequencing for most of the azole-resistant isolates.
RESULTS
Of 230 isolates, 64 (28%) were azole resistant. In 2008 and 2009, 14% and 20% of patients had resistant isolates, respectively. During this period 62 of 64 (97%) were itraconazole resistant, 2 of 64 (3%) were only voriconazole resistant and 78% of cases were multi-azole resistant. Forty-three percent of isolates did not carry a cyp51A mutation (previously the most common azole resistance mechanism), indicating that other mechanisms must be responsible and are increasing in frequency.
CONCLUSIONS
Azole resistance is evolving and growing in frequency. Established and novel mechanisms may be responsible.
目的
烟曲霉对唑类抗真菌药物的耐药性目前在某些地区是一个主要的临床问题。在此，我们根据 2008-09 年的数据更新了我们之前的经验。
方法
我们测试了 2008 年和 2009 年提交给曼彻斯特真菌学参考中心的所有烟曲霉分离株对伊曲康唑、伏立康唑和泊沙康唑的敏感性。我们对大多数唑类耐药分离株进行了 CYP51A 测序。
结果
在 230 株分离株中，有 64 株（28%）对唑类药物耐药。在 2008 年和 2009 年，分别有 14%和 20%的患者分离出耐药株。在此期间，62 株（97%）为伊曲康唑耐药，2 株（3%）仅对伏立康唑耐药，78%的病例为多唑类耐药。43%的分离株未携带 cyp51A 突变（以前是最常见的唑类耐药机制），表明其他机制也必须负责且其频率正在增加。
结论
唑类耐药性正在演变并变得更加普遍。已建立的和新的机制可能是耐药的原因。
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