Department of Dermatology, Transilvania University, Brasov, Romania.
Mycoses. 2014 Mar;57(3):129-34. doi: 10.1111/myc.12114. Epub 2013 Jul 25.
Although the therapeutic efficacy of antifungals is well known for dermatophytosis in general population, limited data exist for patients with chronic kidney disease. The objectives of this study were to determine the dermatophyte species causing infection in patients with end-stage renal disease (ESRD) and in vitro susceptibility of isolated dermatophytes to antifungals. A total of 87 patients with ESRD who undergoing haemodialysis and 105 patients with normal renal function suspected with dermatophytosis were included. Skin scrapings or nail clippings were examined by direct microscopy and cultured on Sabouraud agar. In vitro antifungal susceptibility tests were performed using a broth microdilution method. Dermatophyte infections were identified in 32.2% of haemodialysis patients and in 29.5% of controls (P > 0.05). In both groups, Trichophyton rubrum was the most frequently isolated. Mean MIC values of the all studied antifungals for all of isolated dermatophyte strains from patients with ESRD were similar to those obtained in control group (P > 0.05). Terbinafine (TBF) had the lowest mean MIC values for all tested dermatophytes in both groups. We consider that TBF should be the treatment of choice for dermatophytosis in patients with chronic kidney disease, but the dose should be adjusted according to creatinine clearance and should be monitored for side effects.
尽管抗真菌药物对一般人群的皮肤癣菌病的疗效众所周知，但对于慢性肾脏病患者的数据有限。本研究的目的是确定导致终末期肾病（ESRD）患者感染的皮肤癣菌种类以及分离的皮肤癣菌对抗真菌药物的体外敏感性。共有 87 名接受血液透析的 ESRD 患者和 105 名肾功能正常的疑似皮肤癣菌病患者纳入研究。通过直接显微镜检查和沙氏琼脂培养对皮肤刮屑或指甲屑进行检查。采用肉汤微量稀释法进行体外抗真菌药敏试验。血液透析患者的皮肤癣菌感染率为 32.2%，对照组为 29.5%（P>0.05）。两组中，红色毛癣菌的分离率均最高。来自 ESRD 患者的所有分离皮肤癣菌株的所有研究抗真菌药物的平均 MIC 值与对照组相似（P>0.05）。特比萘芬（TBF）在两组中对所有测试的皮肤癣菌的平均 MIC 值最低。我们认为 TBF 应该是慢性肾脏病患者皮肤癣菌病的首选治疗药物，但应根据肌酐清除率调整剂量，并应监测副作用。
