Żyrek Dawid, Nowicka Joanna, Pajączkowska Magdalena, Morgiel Ewa
Department of Microbiology, Faculty of Medicine, Wrocław Medical University, 50-367 Wrocław, Poland.
Department of Rheumatology and Internal Medicine, Faculty of Medicine, Wrocław Medical University, 50-367 Wrocław, Poland.
Antibiotics (Basel). 2021 Oct 26;10(11):1302. doi: 10.3390/antibiotics10111302.
Research confirms that spp. incubated with methotrexate develop multi-drug resistance to azoles, but it is not clear whether this phenomenon occurs in vivo in patients treated with cytostatics. The aim of the study was to assess whether systemic methotrexate therapy induces resistance to azoles among endogenous strains in patients with rheumatological diseases.
The test group consisted of 52 rheumatological patients on methotrexate therapy, who have never been exposed to fluconazole. The control group was composed of 49 individuals who have never been exposed to either methotrexate or fluconazole. Oral swab and clinical information were obtained from each participant. The acquired material was cultured, then each strain was isolated and identified (MALDI TOF). Subsequently, minimal inhibitory concentration (MIC) for fluconazole was determined.
MIC values ranged from <0.125 to 64 µg/mL with the most common result <0.125 µg/mL. Samples obtained from 4 patients of the test group and 2 patients of the control group contained strains resistant to fluconazole.
Despite slightly higher incidence of fluconazole-resistant strains among patients on systemic methotrexate therapy, we found no solid evidence to support the hypothesis that methotrexate induces resistance to azoles among endogenous strains in patients with rheumatological diseases.
研究证实，与甲氨蝶呤共同孵育的 种会对唑类产生多药耐药性，但尚不清楚这种现象在接受细胞抑制剂治疗的患者体内是否会发生。本研究的目的是评估全身性甲氨蝶呤治疗是否会在风湿性疾病患者的内源性 菌株中诱导对唑类的耐药性。
试验组由52名接受甲氨蝶呤治疗且从未接触过氟康唑的风湿性疾病患者组成。对照组由49名从未接触过甲氨蝶呤或氟康唑的个体组成。从每位参与者处获取口腔拭子和临床信息。对获取的材料进行培养，然后分离并鉴定每个菌株（基质辅助激光解吸电离飞行时间质谱）。随后，测定氟康唑的最低抑菌浓度（MIC）。
MIC值范围为<0.125至64μg/mL，最常见的结果为<0.125μg/mL。从试验组的4名患者和对照组的2名患者获取的样本中含有对氟康唑耐药的菌株。
尽管接受全身性甲氨蝶呤治疗的患者中氟康唑耐药菌株的发生率略高，但我们没有确凿证据支持甲氨蝶呤会在风湿性疾病患者的内源性 菌株中诱导对唑类耐药性这一假设。
