恶性肿瘤患者念珠菌临床分离株的药物敏感性分析

目的 以美国临床实验室标准化委员会（NCCLS） M27-A方案的微量肉汤稀释法为金标准,评价丹麦ROSCO公司的纸片扩散法在检测念珠菌耐药性方面的应用价值,为临床实验室寻找一种简便的念珠菌药敏试验方法.方法 分别采用丹麦ROSCO公司抗真菌药敏纸片和法国生物梅里埃公司ATBFUNGUR2念珠菌药敏板条来检测78株常见念珠菌对5-氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑等4种抗真菌药物的敏感性,以NCCLS的微量稀释法作为金标准,评价纸片扩散法的灵敏度、特异度、阳性预测值、阴性预测值.结果 纸片扩散法检测5-氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑的药敏结果,其Kappa值达到了0.89,未出现一种方法敏感而另一种方法耐药的严重错误现象;对78株念珠菌的药敏结果进行分析,5-氟胞嘧啶、两性霉素B敏感性高,分别为88.20％和89.17％,氟康唑和伊曲康唑敏感性较低,分别为56.34％和52.12％.白色念珠菌和热带念珠菌对4种抗真菌药物的敏感性较高,分别为90.95％、85.71％,而光滑念珠菌和克柔念珠菌的敏感性低,分别为67.50％、41.67％.结论 纸片扩散法与微量稀释法一致性高,在临床实验室可以替代微量稀释法进行念珠菌的药敏分析.我院念珠菌对两性霉素B的敏感性最高,对伊曲康唑的敏感性最低;抗真菌药物对白色念珠菌的抑菌率最高,对克柔念珠菌的抑菌率最低.

Study of susceptibility of candida species in patients with malignant tumors

Objective To evaluate the clinical application of disk diffusion method（ROSCO company of Denmark） for testing the susceptibility of candida species isolated from patients with cancer with the using broth microdilution method （ （NCCLS） M27-A of America Committee for clinical laboratory standards） as the gold standard in order to find the better method for clinical laboratory. Methods Antifungal susceptibility （5- flucytosine,amphotericin B,fluconazole and itraconazole） of 78 strains of Candida species were tested both by ROSCO disk diffusion method and ATB FUNGUR2 broth microdilution method. The microdilution method NCCLS as the gold standard. The sensitivity, specificity, positive and negative predictive values of two methods was calculated. Results The Kappa value was reached to .0. 89 in term of disk diffusion method for detecting susceptibility of eandida to 5-flucytosine, amphotericin B, fluconazole and itraconazole, suggesting that no serious errors was seen in terms of sensitive and resistant another method. Of 78 strains of candida, they had the high susceptibility to 5-flucytosine, amphotericin B,which were 88.20% and 89. 17%. The lower susceptibility of 78 strains of eandida was fluconazole and itraconazole （56. 34% and 52. 12% ）. Candida glabrata and candida krusei were proved to suspect to four kinds of antifungal agents（90. 95%, 85.71% ）. And the lowest positivity was 67. 50% and 41.67% regarding of candida glabrata and candida krusei. Conclusion The higher consistency was seen in terms of detecting candida susceptibility to antibiotics by disk diffusion method and microdilution method, suggesting disk diffusion method can replace microdilution method. In our hospital, candida species are susceptibility to amphotericin B at the highest sensitivity and courtyard albicans at lower sensitivity. Antifungal agents works to candida albicans and lower inhibition rate to candida kruse.