Correlation between Triazole Treatment History and Susceptibility in Clinically Isolated Aspergillus fumigatus

被引：73

作者：

Tashiro, Masato ^{[1
]}

Izumikawa, Koichi ^{[1
]}

Hirano, Katsuji ^{[1
]}

Ide, Shotaro ^{[1
]}

Mihara, Tomo ^{[1
]}

Hosogaya, Naoki ^{[1
,5
]}

Takazono, Takahiro ^{[1
]}

Morinaga, Yoshitomo ^{[3
]}

Nakamura, Shigeki ^{[1
]}

Kurihara, Shintaro ^{[4
]}

Imamura, Yoshifumi ^{[1
]}

Miyazaki, Taiga ^{[1
]}

Nishino, Tomoya ^{[1
]}

Tsukamoto, Misuzu ^{[4
]}

Kakeya, Hiroshi ^{[1
]}

Yamamoto, Yoshihiro ^{[1
]}

Yanagihara, Katsunori ^{[3
]}

Yasuoka, Akira ^{[4
]}

Tashiro, Takayoshi ^{[2
]}

Kohno, Shigeru ^{[1
]}

机构：

[1] Nagasaki Univ, Grad Sch Biomed Sci, Dept Mol Microbiol & Immunol, Nagasaki 852, Japan

[2] Nagasaki Univ, Grad Sch Biomed Sci, Dept Hlth Sci, Nagasaki 852, Japan

[3] Nagasaki Univ Hosp, Dept Lab Med, Nagasaki, Japan

[4] Nagasaki Univ, Nagasaki Univ Hosp, Infect Control & Educ Ctr, Nagasaki 852, Japan

[5] Univ Yamanashi, Dept Internal Med 2, Chuo, Japan

来源：

ANTIMICROBIAL AGENTS AND CHEMOTHERAPY | 2012年 / 56卷 / 09期

关键词：

CHRONIC PULMONARY ASPERGILLOSIS; AZOLE RESISTANCE; ANTIFUNGAL RESISTANCE; RESPIRATORY SAMPLES; CYP51A GENE; ITRACONAZOLE; IDENTIFICATION; VORICONAZOLE; MUTATIONS; PATIENT;

D O I：

10.1128/AAC.00514-12

中图分类号：

Q93 [微生物学];

学科分类号：

071005 ; 100705 ;

摘要：

This is the first report of a detailed relationship between triazole treatment history and triazole MICs for 154 Aspergillus fumigatus clinical isolates. The duration of itraconazole dosage increased as the itraconazole MIC increased, and a positive correlation was observed (r = 0.5700, P < 0.0001). The number of itraconazole-naive isolates dramatically decreased as the itraconazole MIC increased, particularly for MICs exceeding 2 mu g/ml (0.5 mu g/ml versus 2 mu g/ml, P = 0.03). We also examined the relationship between cumulative itraconazole usage and the MICs of other azoles. A positive correlation existed between itraconazole dosage period and posaconazole MIC (r = 0.5237, P < 0.0001). The number of itraconazole-naive isolates also decreased as the posaconazole MIC increased, particularly for MICs exceeding 0.5 mu g/ml (0.25 mu g/ml versus 0.5 mu g/ml, P = 0.004). Conversely, the correlation coefficient obtained from the scattergram of itraconazole usage and voriconazole MICs was small (r = -0.2627, P = 0.001). Susceptibility to three triazole agents did not change as the duration of voriconazole exposure changed. In addition, we carried out detailed analysis, including microsatellite genotyping, for isolates obtained from patients infected with azole-resistant A. fumigatus. We confirmed the presence of acquired resistance to itraconazole and posaconazole due to a G54 substitution in the cyp51A gene for a patient with chronic pulmonary aspergillosis after oral itraconazole therapy. We should consider the possible appearance of azole-resistant A. fumigatus if itraconazole is used for extended periods.

引用

页码：4870 / 4875

页数：6

共 33 条

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