Rodríguez-Tudela J L, Martínez-Suárez J V, Dronda F, Laguna F, Chaves F, Valencia E
Unidad de Micología, Instituto de Salud Carlos III, Madrid, Spain.
J Antimicrob Chemother. 1995 Jun;35(6):793-804. doi: 10.1093/jac/35.6.793.
The in-vitro susceptibilities of 40 clinical isolates of Candida albicans to ketoconazole and fluconazole were determined and an attempt was made to correlate these data with the clinical responses of the patients from whom the strains were originally isolated to treatment with these agents. Of 40 patients with the acquired immunodeficiency syndrome (AIDS) with oropharyngeal and/or oesophageal candidosis, 21 received ketoconazole and 19 fluconazole. Susceptibility testing was performed by a microbroth dilution method with RPMI-2% glucose medium according to the recommendations of the National Committee for Clinical Laboratory Standards; growth inhibition was estimated spectrophotometrically and the MIC endpoint was defined in terms of the IC1/2. The MICs of 236 additional strains of C. albicans, which were also isolated from AIDS patients, were used to establish a susceptibility profile for this species. On the basis of the susceptibility test results and the clinical responses of the 40 patients, the following tentative breakpoints for ketoconazole and fluconazole are proposed: patients with infections caused by C. albicans strains with MICs of ketoconazole and fluconazole or < or = 0.001 and < or = 0.25 mg/L respectively would be expected to respond to treatment with these agents and isolates with MICs which meet these criteria are therefore classified as susceptible; patients with infections caused by strains with MICs of ketoconazole and fluconazole of > or = 0.06 and > or = 16.0 mg/L respectively would not be expected to respond to treatment with these agents and isolates with MICs which meet these criteria are therefore classified as resistant; the response of patients with infections caused by strains with MICs of ketoconazole and fluconazole of 0.003-0.03 and 0.5-8.0 mg/L respectively cannot be reliably predicted and isolates with MICs which fall within these ranges are therefore classified as being of indeterminate susceptibility. The present study demonstrates that the results of in-vitro susceptibility testing with RPMI-2% glucose broth correlate with the clinical response to therapy and can be used to facilitate optimal treatment in AIDS patients with oropharyngeal and/or oesophageal candidosis.
测定了40株白色念珠菌临床分离株对酮康唑和氟康唑的体外敏感性，并尝试将这些数据与最初分离出这些菌株的患者使用这些药物治疗后的临床反应相关联。40例获得性免疫缺陷综合征（AIDS）合并口咽和/或食管念珠菌病的患者中，21例接受酮康唑治疗，19例接受氟康唑治疗。根据美国国家临床实验室标准委员会的建议，采用微量肉汤稀释法在RPMI-2%葡萄糖培养基中进行药敏试验；通过分光光度法估计生长抑制情况，并根据IC1/2定义MIC终点。另外236株也从AIDS患者中分离出的白色念珠菌菌株的MIC用于建立该菌种的敏感性图谱。根据40例患者的药敏试验结果和临床反应，提出了以下酮康唑和氟康唑的暂定断点：由白色念珠菌菌株引起的感染患者，若酮康唑和氟康唑的MIC分别≤0.001和≤0.25mg/L，则预期对这些药物治疗有反应，因此符合这些标准的分离株分类为敏感；由MIC分别≥0.06和≥16.0mg/L的菌株引起感染的患者，预期对这些药物治疗无反应，因此符合这些标准的分离株分类为耐药；由酮康唑和氟康唑的MIC分别为0.003 - 0.03和0.5 - 8.0mg/L的菌株引起感染的患者的反应无法可靠预测，因此MIC落在这些范围内的分离株分类为敏感性不确定。本研究表明，RPMI-2%葡萄糖肉汤体外药敏试验结果与治疗的临床反应相关，可用于促进AIDS合并口咽和/或食管念珠菌病患者的优化治疗。
