Arikan S, Akova M, Hayran M, Ozdemir O, Erman M, Gür D, Unal S
Department of Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey.
Clin Infect Dis. 1998 Apr;26(4):903-8. doi: 10.1086/513927.
We investigated the correlation between in vitro susceptibility to fluconazole and clinical response in severely ill patients with oropharyngeal candidiasis treated with fluconazole. The study included 48 adult patients, of whom 23 were neutropenic (absolute neutrophil count, < 500/mm3). Forty-eight isolates (20 Candida albicans, 12 Candida krusei, 10 Candida kefyr, 3 Torulopsis glabrata, and 3 Candida tropicalis) were tested for susceptibility to fluconazole with use of the macrodilution method of the National Committee for Clinical Laboratory Standards. A strain was considered to be susceptible to fluconazole if the MIC was < or = 8 micrograms/mL and resistant if the value was > or = 64 micrograms/mL. All but one of the resistant strains were C. krusei isolates. Species of causative Candida, persistent neutropenia, and susceptibility to fluconazole were significant predictors of clinical response by univariate analysis. Logistic regression analysis indicated that the only significant factor was the species of Candida isolates, validating the recently recommended MIC breakpoint and the correlation between clinical outcome and in vitro antifungal susceptibility.
我们研究了氟康唑体外药敏性与接受氟康唑治疗的重症口咽念珠菌病患者临床反应之间的相关性。该研究纳入了48例成年患者，其中23例为中性粒细胞减少症患者（绝对中性粒细胞计数<500/mm³）。采用美国国家临床实验室标准委员会的常量稀释法，对48株分离菌株（20株白色念珠菌、12株克柔念珠菌、10株解脂念珠菌、3株光滑念珠菌和3株热带念珠菌）进行氟康唑药敏试验。若最低抑菌浓度（MIC）≤8微克/毫升，则认为该菌株对氟康唑敏感；若MIC值≥64微克/毫升，则认为该菌株耐药。除1株耐药菌株外，其余所有耐药菌株均为克柔念珠菌分离株。单因素分析显示，致病念珠菌的种类、持续性中性粒细胞减少症以及对氟康唑的敏感性是临床反应的重要预测因素。逻辑回归分析表明，唯一的显著因素是念珠菌分离株的种类，这证实了最近推荐的MIC界值以及临床结局与体外抗真菌药敏性之间的相关性。
