Sensibilidad in vitro de hongos miceliales de aislamientos clínicos en pacientes con cáncer en el Instituto Nacional de Cancerología ESE

Article information

Resumen

Introducción

la sensibilidad antifúngica in vitro en hongos filamentosos no ha tenido el mismo desarrollo que en levaduras. Se dispone de limitada información sobre la susceptibilidad en este tipo de aislamientos en Colombia.

Materiales y métodos

se determinó la actividad in vitro de fluconazol, voriconazol, itraconazol, anfotericina B y caspofungina mediante el método de E-Test, de los géneros Aspergillus (36 A. fumigatus, 12 A. flavus, 9 A. niger, 6 A. terreus, 4 A. nidulans y 1 A. versicolor) e hifomicetes hialinos (9 Fusarium sp., 2 Geotrichum sp. y 2 Paecilomyces sp.), provenientes en su mayoría de lavados broncoalveolares (30%) y biopsias pulmonares (36%); 9% provenían de hemocultivos.

Resultados

el perfil de resistencia general fue 28% para itraconazol, 15% para caspofungina, 14% para anfotericina B y 5% para voriconazol. En general, todos los aislamientos presentaron una sensibilidad disminuida para fluconazol e itraconazol. La mejor actividad farmacológica la presentaron voriconazol, caspofungina y anfotericina B. Fusarium sp. presentó una mayor actividad con el voriconazol. Se encontraron diferencias entre el tipo de micelio (Aspergillus vs no Aspergillus) y la susceptibilidad a voriconazol, anfotericina B y caspofungina.

Conclusión

en general, los antimicóticos disponibles para el tratamiento de infecciones por miceliales muestran una sensibilidad disminuida in vitro en relación con el género y la especie identificada.

Palabras clave:

pruebas de sensibilidad microbiana

pruebas antimicrobianas de difusión por disco

hongos

aspergillus

fusarium

agentes antifúngicos

resistencia a medicamentos

Abstract

Introduction

fungal susceptibility against micelial fungi has not been developed at the same pace as susceptibility against yeasts. Scarce information is available about that kind of isolates in Colombia.

Materials and methods

in vitro susceptibility against micelial isolates from patients with cancer was determined. The E-test method was used to find out susceptibility against fluconazole, voriconazole, itraconazole, amphotericin B, and caspofungin. Isolates of the genera Aspergillus (36 A. fumigatus, 12 A. flavus, 9 A. niger, 6 A. terreus, 4 A. nidulans and one A. versicolor isolate), Fusarium (n = 9), Geotrichum and Paecilomyces (n = 2 each one) obtained from patients with cancer were tested. These isolates were obtained from bronchoalveolar lavage (30%), pulmonary biopsies (36%) and bloodstream infections (9%).

Results

The general pattern of resistance was 28% against intraconazole, 15% against caspofungin, 14% against amphotericin B, and 5% against voriconazole. In general, susceptibility against fluconazole and itraconazole showed a diminishing trend. Voriconazole, caspofungin, and amphotericin B showed the best pharmacologic potency. Fusarium sp. presented a higher activity level against voriconazole. There were differences in the susceptibility against voriconazole, anphotericin B, and caspofungin depending on the type of micelial isolate (Aspergillus vs. Non- Aspergillus).

Conclusion

In general, the available antifungal treatments against mycelial fungi identified in the cancer center show diminished susceptibility.

Keyswords:

microbial sensitivity tests

disk diffusion antimicrobial tests

fungus drug sensitivity tests

aspergillus

fusarium

antifungal agents

Amphotericin B

Voriconazole

Itraconazole

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