抗真菌药物敏感性试验方法的新进展

真菌感染,尤其是免疫低下患者机会性真菌感染发病率的不断上升使真菌病的治疗面临着严峻的挑战,各种新的抗真菌药物纷纷涌现。临床实践中,人们需要规范快速、易于应用的药敏试验来指导用药和判断预后,抗真菌药物敏感性试验在真菌感染的治疗中起着重要作用。     

泊沙康唑对临床来源接合菌的体外抗菌活性研究

目的研究泊沙康唑对临床来源的接合菌体外抗菌活性。方法对临床来源的43株接合菌采用ITS区序列分析进行准确鉴定,采用E-test纸片法研究泊沙康唑对43株菌的体外药物敏感性,观察其MIC值。结果经ITS序列分析鉴定,43株临床来源接合菌中最为常见的是小孢根霉和不规则毛霉(各12株),其次为米根霉(10株),ramosa(3株)。其他菌种分别为ornata、总状共头霉、微小根毛霉、卷曲毛霉、印度毛霉和冻土毛霉各1株。E-test纸片法测得泊沙康唑对毛霉属、根霉属和Lichtheimia spp.的MIC值范围分别为0.19～>32μg/mL、0.19～3μg/mL、0.002～0.38μg/mL,对总状共头霉和微小根毛霉的MIC值分别为1μg/mL和0.19μg/mL。结论泊沙康唑对大部分接合菌有效,不同种属MIC值范围不同,毛霉属真菌的MIC值差异较大。     

Comparison of disc diffusion and epsilometer (E-test) testing techniques to determine antimicrobial susceptibiliy of Campylobacter isolates of food and human clinical origin

The antibiotic resistance profiles of 75 Campylobacter isolates of food and human clinical origin was determined by two agar diffusion susceptibility methods; disc diffusion and epsilometer-test (E-test). The most common therapeutic antimicrobials, erythromycin, ciprofloxacin and tetracycline were studied, along with chloramphenicol, ampicillin and naladixic acid. The resistance observed for each antimicrobial, as determined by both of methods, were statistically compared using Fisher two-tailed analysis.Of the six antimicrobials studied only two were shown to have statistically different patterns when resistance was compared by disc diffusion and E-test. The percentage of isolates resistant to clinically relevant antimicrobials using both techniques ranged from 6.6 to 21.3% for erythromycin, 25.3–26.6% for tetracycline and 33.3–36.0% for ciprofloxacin. The prevalence of multi-drug resistant (MDR) campylobacters (isolates resistant to 2 or more antimicrobials) for both disc diffusion and E-test was 44%. It can be concluded that, for four of the six antimicrobials assessed, antimicrobial resistance prevalences could be equally determined by either of the methods studied.     

临床相关毛孢子菌的鉴定及体外药物敏感性研究

目的探讨临床相关毛孢子菌的鉴定方法及对常见抗真菌药物的体外敏感性。方法对48株临床分离的毛孢子菌分别通过形态学、API20C AUX、Vitek 2 Compact及核糖体rDNA ITS序列分析等方法鉴定到种;采用浓度梯度法（E-test）测定氟康唑、伏立康唑、伊曲康唑、两性霉素B及卡泊芬净对48株毛孢子菌的最低抑菌浓度。结果形态学和API20C AUX、Vitek 2 Compact不能准确区分不同种的毛孢子菌,以核糖体rDNA ITS序列分析将48株毛孢子菌鉴定为8个种：阿萨希毛孢子菌,星型毛孢子菌,皮瘤毛孢子菌,真皮毛孢子菌,皮肤毛孢子菌,赖巴克毛孢子菌,T.domesticum,T.jirovecii。体外药敏结果显示：卡泊芬净对毛孢子菌无体外活性,MIC〉32μg/mL;氟康唑和两性霉素B对毛孢子菌活性差,体外活性最好的药物是伏立康唑和伊曲康唑。结论常规方法不易将毛孢子菌准确鉴定到种的水平,ITS序列分析准确快速,可以辅助临床区分难鉴定毛孢子菌。毛孢子菌药敏谱不同于临床常见其他酵母菌,氟康唑和两性霉素B对其活性差,伏立康唑具有良好的体外抗菌活性。     

E-test antibiotics susceptibility of strict anaerobic bacteria

The E-test is convenient for testing susceptibility of anaerobes. From September 1998 to September 1999, 194 strains (105 Gram-positive bacteria, 89 Gram-negative bacteria) of clinically relevant samples were tested against five antibiotics benzylpenicillin, amoxicillin-clavulanic acid, clindamycin, metronidazole and imipenem on blood agar plates. Resistance to benzyl penicillin is widespread and Gram-negative bacteria and resistance to amoxicillin-clavulanic acid is exceptional. Metronidazole is very effective against anaerobes except non-spore-forming aerotolerant Gram-positive rods and Peptostreptococcus micros.     

Use of folic acid casei medium reveals trimethoprim susceptibility of Lactobacillus species

AIM: Lactobacilli have been reported to have intrinsic resistance to trimethoprim. The susceptibility of lactobacilli to trimethoprim on different media was investigated in order to search for a phenotypic test method that could indicate the presence of acquired resistance genes. METHODS AND RESULTS: Strains of Lactobacillus acidophilus, Lact. paracasei, Lact. rhamnosus and Lact. plantarum were susceptibility tested with E-tests on folic acid casei medium (FACM), MRS and defined medium 1. The effects of addition or removal of nucleosides and thymidine phosphorylase were investigated. E-tests on FACM yielded reproducible minimal inhibitory concentrations (MICs) for trimethoprim but addition of nucleosides was necessary for growth of Lact. acidophilus. MICs for the tested strains were 0.125-0.19, 0.25-3 and 0.064-0.19 microg ml(-1) for Lact. paracasei, Lact. rhamnosus and Lact. plantarum, respectively. With the addition of deoxyuridine and deoxyadenosine to FACM the MICs of Lact. acidophilus were 0.064-1 microg ml(-1). CONCLUSIONS, SIGNIFICANCE AND IMPACT OF THE STUDY: Lactobacilli do not have intrinsic resistance to trimethoprim. The results show that trimethoprim susceptibility testing of the tested Lactobacillus species is possible and indicate that transferable resistance genes are absent in all the tested strains.     

in Vitro Activity of Antimycotic Agents Determined by e-Test Method Against Vaginal Shape Candida Species

Vaginal candidiasis continues to be a common cause of vaginal discharge, pruritus and other local complaints in women worldwide. Although numerous antimycotic agents are available for the treatment of yeast vaginitis there is little comparative data on the in vitro activity of these drugs. The objectives of this study were to isolate and identify the Candida species in the vagina and anus of patients treated in a gynaecology clinic, as well as determine the susceptibility to azolic compounds measured by the E-test method. Vaginal and rectal swabs were collected from 80 adult non-pregnant patients, seen at a gynaecological clinic, aged 18–59 years, with sexual activity, with and without vaginitis. The swabs were processed by methods routinely used for the detection of pathogenic yeasts. The susceptibility of the isolates to fluconazole, ketoconazole and itraconazole, was measured by the agar diffusion method (E-test), using RPMI 1640 medium with 2% glucose and phosphate buffer. Candida species (33) strains were isolated from 17 patients at similar proportions from both anatomical sites, and 12 patients harboured 24 strains of C. albicans in the vaginal and rectal tracts. Twenty one percent of the strains of C. albicans were resistant to ketoconazole, 54% were resistant to itraconazole and 0% were resistant to fluconazole. The sensitivity of strains isolated from the two sites were similar, indicating that these are strains of the same phenotype. This revised version was published online in August 2006 with corrections to the Cover Date.     

两性霉素B和伏立康唑对临床真菌的体外抗菌活性分析

目的比较两性霉素B和伏立康唑对临床真菌的体外抗菌活性。方法用两性霉素B和伏立康唑的E-test条对分离自临床标本的116株真菌进行体外药敏试验,其中热带念珠菌15株,光滑念珠菌14株,近平滑念珠菌11株,克柔念珠菌6株,新生隐球菌8株,阿萨希毛孢子菌9株,烟曲霉29株,黄曲霉15株,黑曲霉1株,镰刀菌属7株,根霉属1株,以ATCC22019光滑念珠菌为质控菌株。结果两性霉素B对阿萨希毛孢子菌、镰刀菌、黄曲霉的MIC90均为64μg/ml,对其余受试菌株的MIC90均≤1μg/ml,伏立康唑对镰刀菌的MIC90为64μg/ml,对大部分受试菌株的MIC90均≤2μg/ml。结论除对某些真菌可能无效外,两性霉素B和伏立康唑可能适用于治疗大多数的真菌感染。     

Determination of antimicrobial susceptibilities of clinically isolated anaerobic bacteria by E-test, ATB-ANA and agar dilution

A total of 60 anaerobic strains were isolated from 322 clinical specimens. These isolates were tested for susceptibility to seven antibiotics (penicillin G, amoxicillin/clavulanic acid, cefoxitin, imipenem, chloramphenicol, metronidazole, clindamycin) by using ATB-ANA and Epsilometer test (E-test) strips and the results were compared with the gold standard agar dilution method. Imipenem was found as the most effective agent in vitro among the agents tested (100%). Susceptibility to penicillin G, amoxicillin/clavulanic acid, cefoxitin, chloramphenicol, metronidazole and clindamycin are 36.7%, 83.3%, 88.3%, 96.6%, 85% and 90%, respectively. E-test has showed a good correlation (r=0.62, p=0.001) statistically with the results of agar dilution (total agreement for all antibiotics changing between 90.01% and 98.45%) and a moderate correlation (r=0.45, p=0.048) with the results of ATB-ANA method (total agreement for all antibiotics changing between 75.46% and 98.76%). However, the routine use of agar dilution procedure is concluded to be cumbersome, whereas E-test method offers a reliable alternative.