目的 了解伊曲康唑和羟基伊曲康唑对临床常见深部感染真菌的体外敏感性,并对两者抗菌活性进行比较分析.方法 酵母菌分离自血液和无菌体液标本,曲霉菌分离自气管插管吸取物、支气管肺泡灌洗液和保护性毛刷；酵母菌采用显色培养基和API 20C鉴定到种,曲霉菌用乳酸酚棉兰压片镜检鉴定到种；微量肉汤稀释法进行药敏试验.结果 全国10家医院共收集到338株真菌,包括念珠菌281株,曲霉菌37株,新生隐球菌18株和其他酵母菌2株.伊曲康唑(ITZ)对白念珠菌、热带念珠菌、近平滑念珠菌、克柔念珠菌的敏感率分别为83.8％,70.8％,78.6％,38.5％；50％以上克柔念珠菌为剂量依赖性敏感；伊曲康唑对光滑念珠菌敏感性较差；而对于新生隐球菌、黄曲霉和烟曲霉的MIC50/MIC90分别为0.5/0.5、1/1、1/1 μg/mL；羟基伊曲康唑与伊曲康唑有相似的抗菌活性.结论 伊曲康唑对大部分深部感染真菌的敏感性较好,光滑念珠菌对伊曲康唑耐药株增多；伊曲康唑主要代谢产物有体外抗菌活性.%Objective The in vitro activities of itraconazole and hydroxyl-itraconazole against clinically important fungi isolates were tested and compared. Methods The yeast isolates were obtained from blood and normal sterile body fluids, and the Aspergillus isolates were from deep respiratory specimens. The yeast isolates were identified by CHROMagar medium , API 20C and microscopy for Aspergillus strains. Broth microdilution testing was carried out according to CLSI document exactly. Results From 10 hospitals, we collected 338 pathgentic fungi, including 281 strains of Candida spp, 37 strains of Aspergillus spp, 18 strains of Cryptococcus neoformans and 2 other yeasts isolates. Itraconazole exhibited good activities to most yeast isolates. The susceptible rate of Candida albicans ,C. tropicallis,C. parapsilosis ,C. krusei were 83. 8% ,70. 8% ,78. 6% ,38. 5% , respectively;more than 50% C. krusei isolates were susceptible dose dependent; respectively. Itraconazole has less susceptibility to C. glabrata . To Cryptococcus neoformans, Aspergillus fumigatus ,A.flavus , the MIC50/MIC90 were 0. 5/0. 5、1/1 、1/1 μg/mL, respectively. The antifungal activity of H-ITZ is similar to ITZ with against isolates tested. Conclusion Itraconazole has good activity against most pathgentic fungi tested, resistant isolates increased among C. glabrata ;the major metabolite of itraconazole has in vitro antifungal activity.
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