Jenks Jeffrey D, Spiess Birgit, Buchheidt Dieter, Hoenigl Martin
Department of Medicine, University of California San Diego, San Diego, CA 92103, USA.
Department of Hematology and Oncology, Scientific Laboratory, University Hospital Mannheim, Heidelberg University, Pettenkoferstraße 22, 68169 Mannheim, Germany.
Curr Fungal Infect Rep. 2019 Sep;13(3):129-136. doi: 10.1007/s12281-019-00342-w. Epub 2019 Jun 20.
The incidence of invasive aspergillosis has increased substantially over the past few decades, accompanied by a change in susceptibility patterns of with increasing resistance observed against triazole antifungals, including voriconazole and isavuconazole, the most commonly used antifungal agents for the disease. Culture-based methods for determining triazole resistance are still the gold standard but are time consuming and lack sensitivity. We sought to provide an update on non-culture-based methods for detecting resistance patterns to .
New molecular-based approaches for detecting triazole resistance to , real-time polymerase chain reaction (PCR) to detect mutations to the protein, have been developed which are able to detect most triazole-resistant strains in patients with invasive aspergillosis.
Over the last few years, a number of non-culture-based methods for molecular detection of triazole resistance have been developed that may overcome some of the limitations of culture. These molecular methods are therefore of high epidemiological and clinical relevance, mainly in immunocompromised patients with hematological malignancies, where culture has particularly limited sensitivity. These assays are now able to detect most triazole-resistant strains. Given that resistance rates vary, clinical utility for these assays still depends on regional resistance patterns.
在过去几十年中，侵袭性曲霉病的发病率大幅上升，同时随着对三唑类抗真菌药物（包括伏立康唑和艾沙康唑，这是治疗该疾病最常用的抗真菌药物）耐药性的增加，药敏模式也发生了变化。基于培养的三唑类耐药性检测方法仍是金标准，但耗时且缺乏敏感性。我们试图提供关于检测对[具体药物或物质，原文此处未明确]耐药模式的非培养方法的最新情况。
已开发出基于分子的新方法来检测对[具体药物或物质，原文此处未明确]的三唑类耐药性，即实时聚合酶链反应（PCR）来检测[具体蛋白质，原文此处未明确]的突变，该方法能够检测侵袭性曲霉病患者中大多数对三唑类耐药的[具体菌株，原文此处未明确]菌株。
在过去几年中，已开发出多种基于分子的非培养方法用于检测[具体药物或物质，原文此处未明确]的三唑类耐药性，这些方法可能克服培养的一些局限性。因此，这些分子方法具有很高的流行病学和临床相关性，主要适用于血液系统恶性肿瘤的免疫受损患者，在这些患者中培养的敏感性特别有限。这些检测方法现在能够检测大多数对三唑类耐药的[具体菌株，原文此处未明确]菌株。鉴于耐药率各不相同，这些检测方法的临床实用性仍取决于区域耐药模式。
