Aspergillus & azoles

Ref ID: 19468

Author:

P.E. Verweij

Author address:

Radboud University Nijmegen Medical Center, the Netherlands

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Azole resistance is an emerging problem in Aspergillus species. As a
consequence there is increased need to determine the in vitro activity
of antifungal agents in order to guide clinical therapy. The reference
methods of CLSI and EUCAST offer a reproducible method that
enables MIC determination. Clinical breakpoints have been published
for the most frequently encountered Aspergillus species, which helps
us to interpret the MIC value.
Following changes in the taxonomy of Aspergillus species, with the
recognition of numerous sibling species, there is increasing evidence
that the in vitro susceptibility of the sibling species differs from that
of the conventional classification. Furthermore, molecular epidemio-
logic studies indicate that the sibling species of Aspergillus may cause
aspergillus diseases. Species identification and in vitro susceptibility
testing is important to investigate the wild type distribution of these
new species.
Acquired resistance has primarily been reported in A. fumigatus.
Multi- and pan azole resistant isolates are increasing found in
patients with chronic aspergillus diseases that have been treated with
medical triazoles. In some regions in the world azole resistant isolates
have been recovered from the environment as well as from clinical
specimens. Azole resistance can be detected using phenotypic meth-
ods, but only in culture-positive cases. Routine in vitro susceptibility
testing is needed in order to determine the frequency of resistance.
The main problem is the early detection of azole resistance, especially
in patients with negative cultures. Direct detection of mutations in
clinical specimens has been described, but there are difficulties given
the wide range of mutations that have been identified to be associ-
ated with an azole resistant phenotype, and the low copy number of
the gene harboring the mutation.
Although in recent years progress has been made in the develop-
ment and validation of tools for in vitro susceptibility testing of aspergilli, there is a increasing need for novel techniques for rapid
testing.

Abstract Number: w17.2

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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