Duus Liv, Schachsen Pernille Kræmer, Gertsen Jan Berg, Astvad Karen Marie Thyssen, Kristensen Lise
Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark.
Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark.
Mycoses. 2025 Jan;68(1):e70011. doi: 10.1111/myc.70011.
Emerging terbinafine resistance in Trichophyton species has been reported globally. The prevalence in clinical samples from patients with treatment failure is unknown in Denmark.
Prospective study of terbinafine resistance in Trichophyton isolates from patients with recalcitrant skin or nail infections.
PATIENTS/METHODS: Clinical samples (nails or skin scrapings) from patients with recalcitrant infections were included. Isolates were tested with the EUCAST broth microdilution method, E.Def 11.0 and DermaGenius Resistance Multiplex PCR kit (PathoNostics, The Netherlands).
Thirty-three isolates were included in the study, 27 (81.8%) T. rubrum, 2 (6.1%) T. interdigitale, 1 (3.0%) T. mentagrophytes and 3 (9.1%) T. indotineae. Sixteen of 31 isolates (52%) were terbinafine resistant with the EUCAST broth microdilution method, 13 T. rubrum and 3 T. indotineae. Two isolates did not grow in the broth culture medium. The DermaGenius Resistance Multiplex PCR kit showed mutations associated with terbinafine resistance in 11 isolates. All of the 11 isolates with detected mutations by PCR also displayed terbinafine resistance by the EUCAST method.
Terbinafine resistance was detected in 52% of Trichophyton isolates from recalcitrant infections by the EUCAST broth microdilution. T. rubrum was the most common species among the resistant isolates (81.3%). The DermaGenius Resistance Multiplex PCR kit was a reliable tool for the detection of mutations associated with terbinafine resistance and is suitable as an initial screening for terbinafine resistance before results from EUCAST broth microdilution testing is available. Susceptibility testing of Trichophyton spp. from skin and nail samples is highly relevant from patients with terbinafine treatment failure.
全球范围内已报道皮肤癣菌对特比萘芬产生新的耐药性。丹麦治疗失败患者临床样本中的耐药率尚不清楚。
对顽固性皮肤或指甲感染患者分离出的皮肤癣菌进行特比萘芬耐药性的前瞻性研究。
患者/方法：纳入顽固性感染患者的临床样本（指甲或皮肤刮屑）。采用欧洲抗菌药物敏感性试验委员会（EUCAST）肉汤微量稀释法、E.Def 11.0和DermaGenius耐药多重PCR试剂盒（荷兰PathoNostics公司）对分离菌株进行检测。
本研究共纳入33株分离菌株，其中红色毛癣菌27株（81.8%）、指间毛癣菌2株（6.1%）、须癣毛癣菌1株（3.0%）、印地毛癣菌3株（9.1%）。采用EUCAST肉汤微量稀释法检测，31株分离菌株中有16株（52%）对特比萘芬耐药，其中红色毛癣菌13株，印地毛癣菌3株。有2株分离菌株在肉汤培养基中未生长。DermaGenius耐药多重PCR试剂盒检测出11株分离菌株存在与特比萘芬耐药相关的突变。通过PCR检测出突变的11株分离菌株经EUCAST方法检测也显示对特比萘芬耐药。
采用EUCAST肉汤微量稀释法检测，52%的顽固性感染皮肤癣菌分离菌株对特比萘芬耐药。耐药分离菌株中最常见的菌种是红色毛癣菌（81.3%）。DermaGenius耐药多重PCR试剂盒是检测与特比萘芬耐药相关突变的可靠工具，适合在EUCAST肉汤微量稀释试验结果出来之前作为特比萘芬耐药性的初步筛查。对于特比萘芬治疗失败的患者，对皮肤和指甲样本中的皮肤癣菌进行药敏试验具有重要意义。
