Correlation of anti-fungal susceptibility with clinical outcomes in patients with cryptococcal meningitis

BMC Infectious Diseases

Cheng-Hsien Lu³  Ya-Fen Tang¹  Chun-Chih Chien¹  Fang-Ju Chen²  Jien-Wei Liu²  Tzu-Yao Chang²  Chen-Hsiang Lee² 

[1] Department of Laboratory Medicine, Kaohsiung, Taiwan;Division of Infectious Diseases, Department of Internal Medicine, Chang Gung University College of Medicine, Kaohsiung, Taiwan;Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan

关键词: Susceptibility;    Outcome;    Fluconazole;    Cryptococcal meningitis;   

Others  :  1158682
DOI  :  10.1186/1471-2334-12-361

 received in 2012-05-17, accepted in 2012-12-18,  发布年份 2012

【 摘 要 】

Background

This study aimed to investigate the correlation of minimum inhibiting concentrations (MICs), obtained by broth micro-dilution, and clinical response in patients with cryptococcal meningitis.

Methods

Using retrospective analyses covering the period 2001–2010, factors affecting clinical therapeutic cure in patients with cryptococcal meningitis 10 weeks after the start of anti-fungal therapy were identified. Specific emphasis was placed on the role of anti-fungal susceptibility.

Results

Of 46 patients with cryptococcal meningitis identified, 21 were cured after 10 weeks of treatment. Overall, 12 strains (26.1%) were resistant to fluconazole (>8 μg/ml) and 8 (17.4%) had an MIC >1 μg/ml for amphotericin B. Twenty-three patients received combination amphotericin B and fluconazole as their initial antifungal therapy, 17 were given amphotericin B only, five received fluconazole only, and one received a combination of amphotericin B and flucytosine. After 2 weeks, all patients received fluconazole (400–600 mg daily for 8 weeks at least, then 200 mg daily thereafter). The presence of isolates resistant to fluconazole (MIC >8 μg/ml; 4.8% vs. 44%, p < 0.01) were statistically significant among patients who were cured. Anti-fungal susceptibility, reflected by fluconazole MIC >8 μg/ml, was an independent predictor of therapeutic cure at 10-week evaluation (OR = 15.7; 95% CI: 1.8-135.9; p = 0.01), but higher MIC of amphotericin B (>1 μg/ml) was not.

Conclusions

The MICs of fluconazole, determined by the CLSI method, may be a potential predictor of therapeutic cure in patients with cryptococcal meningitis.

【 授权许可】

   
2012 Lee et al.; licensee BioMed Central Ltd.

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