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多药敏感性降低是机会性镰刀菌属物种的共同特征:镰刀菌多药耐药模式。

Reduced Multidrug Susceptibility Profile Is a Common Feature of Opportunistic Fusarium Species: Fusarium Multi-Drug Resistant Pattern.

作者信息

Taj-Aldeen Saad J

机构信息

Mycology Unit, Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, P.O. Box 3050 Doha, Qatar.

Weill Cornell Medicine-Qatar, P.O. Box 3050 Doha, Qatar.

出版信息

J Fungi (Basel). 2017 Apr 10;3(2):18. doi: 10.3390/jof3020018.

Abstract

The resistance among various opportunistic species to different antifungal agents has emerged as a cause of public health problems worldwide. Considering the significance of multi-drug resistant (MDR), this paper emphasizes the problems associated with MDR and the need to understand its clinical significance to combat microbial infections. The search platform PubMed/MEDLINE and a review of 32 cases revealed a common multidrug-resistant profile exists, and clinically relevant members of are intrinsically resistant to most currently used antifungals. Dissemination occurs in patients with prolonged neutropenia, immune deficiency, and especially hematological malignancies. Amphotericin B displayed the lowest minimum inhibitory concentrarions (MICs) followed by voriconazole, and posaconazole. Itraconazole and fluconazole showed high MIC values, displaying in vitro resistance. Echinocandins showed the highest MIC values. Seven out of ten (70%) patients with neutropenia died, including those with fungemia that progressed to skin lesions. Clinical isolates displayed a common MDR profile and high MIC values for the most available antifungal agents with species- and strain-specific differences in antifungal susceptibility. Species identification of infections is important. While the use of natamycin resulted in a favorable outcome in keratitis, AmB and VRC are the most used agents for the treatment of fusariosis in clinical settings.

摘要

各种机会性感染菌种对不同抗真菌药物的耐药性已成为全球公共卫生问题的一个原因。考虑到多重耐药(MDR)的重要性,本文强调了与MDR相关的问题以及了解其临床意义以对抗微生物感染的必要性。通过搜索平台PubMed/MEDLINE并回顾32个病例发现,存在一种常见的多重耐药模式,并且相关临床菌种对大多数目前使用的抗真菌药物具有固有耐药性。传播发生在长期中性粒细胞减少、免疫缺陷尤其是血液系统恶性肿瘤的患者中。两性霉素B的最低抑菌浓度(MIC)最低,其次是伏立康唑和泊沙康唑。伊曲康唑和氟康唑的MIC值较高,表现出体外耐药性。棘白菌素的MIC值最高。十名中性粒细胞减少患者中有七名(70%)死亡,包括那些真菌血症进展为皮肤病变的患者。临床分离株显示出常见的多重耐药模式,对大多数现有抗真菌药物的MIC值较高,且在抗真菌敏感性方面存在菌种和菌株特异性差异。感染菌种的鉴定很重要。虽然使用那他霉素治疗角膜炎取得了良好效果,但在临床环境中,两性霉素B和伏立康唑是治疗镰刀菌病最常用的药物。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe94/5715927/a0020aec0674/jof-03-00018-g001.jpg

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