Tantasuwan Suchavadee, Chongtrakool Piriyaporn, Waesamaae Amiroh, Chayakulkeeree Methee
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
J Fungi (Basel). 2022 Nov 10;8(11):1185. doi: 10.3390/jof8111185.
Disk diffusion (DD) is a simple antifungal susceptibility method for . This study examined the impact of fluconazole DD testing on antifungal de-escalation. We enrolled patients with candidemia whose isolates were tested for fluconazole susceptibility using DD between January 2019 and January 2020. The historical controls were patients with candidemia who underwent fluconazole susceptibility testing using the broth microdilution (BMD) method. Clinical data including antifungal therapy were analyzed. In total, 108 patients were enrolled. Most baseline characteristics were comparable between the groups. . was the predominant isolate (54.6%), followed by . (17.6%). The rates of antifungal de-escalation within 72 h were 25.9 and 9.3% in the DD and BMD groups, respectively ( = 0.023). The median time to de-escalation was 3 days in the DD group, versus 6 days in the BMD group ( = 0.037). The 14-day mortality rate and antifungal cost tended to be lower in the DD group. There were no differences in the length of hospital stay and treatment-related complications between the two groups. The agreement between the DD and BMD results was 90%. DD testing can be substituted for BMD to enhance antifungal de-escalation and antifungal stewardship.
纸片扩散法（DD）是一种简单的抗真菌药敏试验方法。本研究探讨了氟康唑纸片扩散试验对抗真菌降阶梯治疗的影响。我们纳入了2019年1月至2020年1月期间念珠菌血症患者，其分离菌株采用纸片扩散法检测氟康唑敏感性。历史对照为采用肉汤微量稀释法（BMD）进行氟康唑敏感性试验的念珠菌血症患者。分析包括抗真菌治疗在内的临床数据。总共纳入了108例患者。两组间大多数基线特征具有可比性。 是主要分离菌株（54.6%），其次是 （17.6%）。纸片扩散法组和肉汤微量稀释法组72小时内抗真菌降阶梯治疗率分别为25.9%和9.3%（ = 0.023）。纸片扩散法组降阶梯治疗的中位时间为3天，而肉汤微量稀释法组为6天（ = 0.037）。纸片扩散法组的14天死亡率和抗真菌成本往往较低。两组间住院时间和治疗相关并发症无差异。纸片扩散法和肉汤微量稀释法结果的一致性为90%。纸片扩散试验可替代肉汤微量稀释法，以加强抗真菌降阶梯治疗和抗真菌管理。
