The diagnosis and treatment of invasive aspergillosis in Dutch haematology units facing a rapidly increasing prevalence of azole resistance. A nationwide survey and rationale for the DB-MSG 002 study protocol.

Author: 

Schauwvlieghe AFAD , de Jonge N , van Dijk K , Verweij PE , , Brüggemann RJ , Biemond BJ , Bart A , von dem Borne PA , Verbon A , van der Beek MT , Demandt AMP , Oudhuis GJ , Cornelissen JJ , van der Velden WJFM, Span LFR, Kampinga GA , Bruns AH , Vonk AG , Haas PA , Doorduijn JK , Rijnders BJA.
Mycoses. 2018 Apr 23.

Abstract: 

BACKGROUND:

Patients with haematological malignancies are at risk for invasive fungal diseases (IFD). A survey was conducted in all Dutch academic haematologycentres on their current diagnostic, prophylactic and therapeutic approach towards IFD in the context of azole resistance.

METHODS:

In all 8 centres, a haematologist and microbiologist filled in the questionnaire that focused on different subgroups of haematology patients.

RESULTS:

Fungal prophylaxis during neutropenia was directed against Candida and consisted of fluconazole and/or amphotericin B suspension. Mould-active prophylaxis was given to acute myeloid leukaemia patients during chemotherapy in two of eight centres. All centres used azole prophylaxis in a subset of patients with graft-versus-host disease. A uniform approach towards the diagnosis and treatment of IFD and in particular azole-resistant Aspergillus fumigatus was lacking. In 2017, all centres agreed to implement a uniform diagnostic and treatment algorithm regarding invasive aspergillosis with a central role for comprehensive diagnostics and PCR-based detection of azole resistance. This study (DB-MSG 002) will re-evaluate this algorithm when 280 patients have been treated.

DISCUSSION:

A heterogeneous approach towards antifungal prophylaxis, diagnosis and treatment was apparent in the Netherlands. Facing triazole-resistance, consensus was reached on the implementation of a uniform diagnostic approach in all eight centres. This article is protected by copyright. All rights reserved.

KEYWORDS:

IFD; Invasive aspergillosis; azole-resistance; management