Clinical implications of azole resistance in Aspergillus fumigatus, The Netherlands, 2007-2009 - PubMed (original) (raw)

Multicenter Study

Clinical implications of azole resistance in Aspergillus fumigatus, The Netherlands, 2007-2009

Jan W M van der Linden et al. Emerg Infect Dis. 2011 Oct.

Abstract

The prevalence and spread of azole resistance in clinical Aspergillus fumigatus isolates in the Netherlands are currently unknown. Therefore, we performed a prospective nationwide multicenter surveillance study to determine the effects of resistance on patient management strategies and public health. From June 2007 through January 2009, all clinical Aspergillus spp. isolates were screened for itraconazole resistance. In total, 2,062 isolates from 1,385 patients were screened; the prevalence of itraconazole resistance in A. fumigatus in our patient cohort was 5.3% (range 0.8%-9.5%). Patients with a hematologic or oncologic disease were more likely to harbor an azole-resistant isolate than were other patient groups (p<0.05). Most patients (64.0%) from whom a resistant isolate was identified were azole naive, and the case-fatality rate of patients with azole-resistant invasive aspergillosis was 88.0%. Our study found that multiazole resistance in A. fumigatus is widespread in the Netherlands and is associated with a high death rate for patients with invasive aspergillosis.

PubMed Disclaimer

Figures

Figure 1

Figure 1

Number of screened Aspergillus spp. isolates per month (bars) and prevalence (%) of azole resistance (line), the Netherlands, 2007–2009. ITZ, itraconazole.

Figure 2

Figure 2

Prevalence (%) of azole-resistant Aspergillus fumigatus infections in university medical centers, the Netherlands, 2007–2009.

Similar articles

Cited by

References

    1. Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2008;46:327–60. 10.1086/525258 - DOI - PubMed
    1. Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. 2002;347:408–15. 10.1056/NEJMoa020191 - DOI - PubMed
    1. Walsh TJ, Pappas P, Winston DJ, Lazarus HM, Petersen F, Raffalli J, et al. Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever. N Engl J Med. 2002;346:225–34. 10.1056/NEJM200201243460403 - DOI - PubMed
    1. Schwartz S, Ruhnke M, Ribaud P, Corey L, Driscoll T, Cornely OA, et al. Improved outcome in central nervous system aspergillosis, using voriconazole treatment. Blood. 2005;106:2641–5. 10.1182/blood-2005-02-0733 - DOI - PubMed
    1. Slobbe L, Polinder S, Doorduijn JK, Lugtenburg PJ, el Barzouhi A, Steyerberg EW, et al. Outcome and medical costs of patients with invasive aspergillosis and acute myelogenous leukemia-myelodysplastic syndrome treated with intensive chemotherapy: an observational study. Clin Infect Dis. 2008;47:1507–12. 10.1086/591531 - DOI - PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources