National Reference Medical Mycology Laboratory, Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Dr Subotica 1, 11000 Belgrade, Serbia.
J Mycol Med. 2012 Sep;22(3):243-8. doi: 10.1016/j.mycmed.2012.06.002. Epub 2012 Aug 10.
Recently, geographic variations in resistance to agents commonly used in the treatment of cryptococcosis have been reported. Therefore, the antifungal susceptibilities of 31 clinical isolates of Cryptococcus neoformans, collected in Serbia during 10-year period, were investigated. Strains were isolated from cerebrospinal fluid (n=28) and blood (n=3), from patients with AIDS (n=26), lymphoma (n=4) and kidney transplant recipient (n=1). The minimal inhibitory concentrations (MICs) of amphotericin B, 5-fluorocytosine, fluconazole and itraconazole were determined by the E-test(®) method. The isolates were highly susceptible to amphotericin B (100% susceptibility at MIC<0.5 μg/mL) and 5-fluorocytosine (87.1% susceptibility at MIC ≤ 4 μg/mL). Geometric mean MIC of amphotericin B and 5-fluorocytosine were 0.102 μg/mL and 0.396 μg/mL, respectively. Fluconazole exhibited the lowest activity in vitro (48.4% susceptibility at MIC ≤ 8 μg/mL) with a significant resistance rate. The activity of itraconazole was also decreased (48.4% susceptibility at MIC ≤ 0.25 μg/mL). The geometric mean MIC of fluconazole stood at 15.14 μg/mL and of itraconazole was 0.144 μg/mL. Cross-resistance among azoles was not common (3.2%), but the parallel increase in fluconazole and itraconazole MIC has been observed (P<0.01). The low rate of susceptibility to fluconazole stresses the need for active antifungal surveillance of C. neoformans and of the corresponding data from different geographic regions.
最近，报道了在治疗隐球菌病常用药物的耐药性方面存在地域差异。因此，对在塞尔维亚收集的 10 年间的 31 株新型隐球菌临床分离株进行了抗真菌药敏性研究。菌株从脑脊液（n=28）和血液（n=3）中分离出来，来自 AIDS（n=26）、淋巴瘤（n=4）和肾移植受者（n=1）的患者。用 E 试验（®）法测定两性霉素 B、5-氟胞嘧啶、氟康唑和伊曲康唑的最小抑菌浓度（MIC）。这些分离株对两性霉素 B（MIC<0.5 μg/mL 时 100%敏感）和 5-氟胞嘧啶（MIC ≤ 4 μg/mL 时 87.1%敏感）高度敏感。两性霉素 B 和 5-氟胞嘧啶的几何平均 MIC 分别为 0.102 μg/mL 和 0.396 μg/mL。氟康唑的体外活性最低（MIC ≤ 8 μg/mL 时 48.4%敏感），耐药率显著升高。伊曲康唑的活性也降低（MIC ≤ 0.25 μg/mL 时 48.4%敏感）。氟康唑的几何平均 MIC 为 15.14 μg/mL，伊曲康唑的几何平均 MIC 为 0.144 μg/mL。唑类药物之间的交叉耐药性并不常见（3.2%），但氟康唑和伊曲康唑 MIC 同时升高的情况也观察到了（P<0.01）。氟康唑的低敏感性率强调了对新型隐球菌进行积极的抗真菌监测以及来自不同地理区域的相应数据的必要性。
