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首页> 外文期刊>Antimicrobial agents and chemotherapy. >In Vitro Activity of Chlorhexidine Compared with Seven Antifungal Agents against 98 Fusarium Isolates Recovered from Fungal Keratitis Patients
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In Vitro Activity of Chlorhexidine Compared with Seven Antifungal Agents against 98 Fusarium Isolates Recovered from Fungal Keratitis Patients

机译：氯己定的体外活性与来自真菌角膜炎患者的98例镰刀菌分离物的七种抗真菌剂相比

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摘要

Fungal keratitis is a common but severe eye infection in tropical and subtropical areas of the world. In regions with a temperate climate, the frequency of infection is rising in patients with contact lenses and following trauma. Early and adequate therapy is important to prevent disease progression and loss of vision. The management of Fusarium keratitis is complex, and the optimal treatment is not well defined. We investigated the in vitro activity of chlorhexidine and seven antifungal agents against a well-characterized collection of Fusarium isolates recovered from patients with Fusarium keratitis. The fungus culture collection of the Center of Expertise in Mycology Radboudumc/CWZ was searched for Fusariurn isolates that were cultured from cornea scrapings, ocular biopsy specimens, eye swabs, and contact lens fluid containers from patients with suspected keratitis. The Fusariurn isolates that were cultured from patients with confirmed keratitis were all identified using conventional and molecular techniques. Antifungal susceptibility testing was performed according to the EUCAST broth microdilution reference method. The antifungal agents tested included amphotericin B, voriconazole, posaconazole, miconazole, natamycin, 5-fluorocytosine, and caspofungin. In addition, the activity of chlorhexidine was determined. The fungal culture collection contained 98 Fusarium isolates of confirmed fungal keratitis cases from 83 Dutch patients and 15 Tanzanian patients. The isolates were collected between 2007 and 2017. Fusarium oxysporurn (n = 24, 24.5%) was the most frequently isolated species followed by Fusarium solani sense stricto (n = 18, 18.4%) and Fusarium petroliphilum (n = 11, 11.2%). Amphotericin B showed the most favorable in vitro inhibition of Fusariurn species followed by natamycin, voriconazole, and chlorhexidine, while 5-fluorocytosine, posaconazole, miconazole, and caspofungin showed no relevant inhibiting effect. However, chlorhexidine showed fungicidal activity against 90% of F. oxysporum strains and 100% of the F. solani strains. Our study supports the clinical efficacy of chlorhexidine and therefore warrants its further clinical evaluation for primary therapy of fungal keratitis, particularly in low and middle income countries where fungal keratitis is much more frequent and, currently, antifungal eye drops are often unavailable.
机译：真菌角膜炎是世界上热带和亚热带地区的常见但严重的眼睛感染。在温带气候的区域中，感染频率在隐形眼镜和创伤后的患者中升高。早期和充足的治疗对于预防疾病进展和失去视力的疗法非常重要。镰刀菌角膜炎的管理是复杂的，并且最佳治疗没有明确定义。我们研究了氯己定和七种抗真菌剂的体外活性，以针对由镰刀菌角膜炎患者回收的镰刀菌分离株的良好集合。搜查了来自涉嫌角膜炎患者的角膜刮擦，眼部活检标本，眼拭子和隐形眼镜流体容器的Fusariurn radboudcc / CWZ中的真菌文化收集。从确诊角膜炎患者培养的培养患者的腐败素分离物使用常规和分子技术鉴定。根据EUCAST肉汤微量稀释参考方法进行抗真菌敏感性测试。测试的抗真菌剂包括两性霉素B，Voriconazole，posaconazole，咪康唑，纳米霉素，5-氟核苷酸和Caspofungin。此外，确定氯己定的活性。真菌培养收集含有98例荷兰患者和15名坦桑尼亚患者确诊的真菌角膜炎病例的98个镰刀菌分离株。在2007年至2017年间收集分离株。镰刀菌（N = 24,24.5％）是最常见的孤立物种，其次是镰刀菌菌丝索感（n = 18,18.4％）和镰刀菌（n = 11,11.2％） 。两性霉素B表现出最有利的体外抑制Fusariurn物种，其次是Natamycin，voriconazole和氯己定，而5-氟核苷酸，吡酰唑，咪康唑和Caspofungin显示出没有相关的抑制作用。然而，氯己定显示出杀菌活性免受90％的F. oxysporum菌株和100％的F.Solani菌株的活性。我们的研究支持氯己定的临床疗效，因此认证其对真菌角膜炎的初次治疗的进一步临床评价，特别是在真菌角膜炎更频繁，目前，抗真菌眼药水通常不可用的低收入和中等收入国家。

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