Tortorano A M, Viviani M A, Barchiesi F, Arzeni D, Rigoni A L, Cogliati M, Compagnucci P, Scalise G
Istituto di Igiene e Medicina Preventiva, Università degli Studi di Milano-IRCCS Ospedale Maggiore di Milano, Milan, Italy.
J Clin Microbiol. 1998 Jun;36(6):1578-83. doi: 10.1128/JCM.36.6.1578-1583.1998.
Three susceptibility testing procedures were compared to determine fluconazole, itraconazole, and ketoconazole MICs against 47 Candida albicans strains isolated sequentially from the oral cavities of five AIDS patients undergoing azole therapy. They included the broth microdilution method (BM), performed according to the National Committee for Clinical Laboratory Standards' tentative standard, the agar dilution method (AD), and the Etest; the latter two tests were performed both in Casitone agar (AD-Cas and Etest-Cas) and in RPMI (AD-RPMI and Etest-RPMI). Twenty-four- and 48-h MICs obtained by AD and Etest were compared with 48-h MICs obtained by BM. The MICs of all the azoles determined by BM were usually lower than those obtained by the other methods, mainly due to different reading criteria. In order to assess the most appropriate way of evaluating the agreement of MICs obtained by different methods with those produced by the proposed reference method (BM), we used the mean differences calculated according to Bland and Altman's method. Comparison of fluconazole MICs obtained by BM and AD-Cas yielded a mean difference of 3, and the percentages of agreement within +/-2 dilutions were 98 and 100% at 24 and 48 h, respectively. For ketoconazole and itraconazole MICs, lower mean differences were noted, and agreement ranged from 96 to 100%. Agreement between the AD-RPMI and BM results was poor for all azoles, and an increase in MICs was always observed between the 1st- and 2nd-day readings. Similarly, Etest-Cas gave better agreement with BM than did Etest-RPMI for all the azoles. BM, AD-Cas, and Etest-Cas each demonstrated a progressive increase in fluconazole MICs against strains isolated sequentially from a given patient, in accordance with the decreased clinical response to fluconazole.
比较了三种药敏试验方法，以确定氟康唑、伊曲康唑和酮康唑对从5名接受唑类治疗的艾滋病患者口腔中依次分离出的47株白色念珠菌的最低抑菌浓度（MIC）。这些方法包括按照美国国家临床实验室标准委员会暂行标准进行的肉汤微量稀释法（BM）、琼脂稀释法（AD）和Etest；后两种试验在酪蛋白胨琼脂（AD-Cas和Etest-Cas）和RPMI中均进行（AD-RPMI和Etest-RPMI）。将AD和Etest获得的24小时和48小时MIC与BM获得的48小时MIC进行比较。BM测定的所有唑类药物的MIC通常低于其他方法获得的MIC，主要是由于读数标准不同。为了评估评估不同方法获得的MIC与提议的参考方法（BM）产生的MIC一致性的最合适方法，我们使用了根据Bland和Altman方法计算的平均差异。BM和AD-Cas获得的氟康唑MIC比较，平均差异为3，在24小时和48小时时，±2倍稀释内的一致性百分比分别为98%和100%。对于酮康唑和伊曲康唑的MIC，观察到较低的平均差异，一致性范围为96%至100%。所有唑类药物的AD-RPMI和BM结果之间的一致性较差，并且在第1天和第2天读数之间总是观察到MIC增加。同样，对于所有唑类药物，Etest-Cas与BM的一致性比Etest-RPMI更好。BM、AD-Cas和Etest-Cas均显示，随着对氟康唑临床反应的降低，针对从给定患者依次分离出的菌株，氟康唑MIC逐渐增加。
