Prospective evaluation of azole resistance in Aspergillus fumigatus clinical isolates in France

Ref ID: 19379

Author:

F. Choukri,2 F. Botterel,2 F. Foulet,2 J. Guillot,3 E. Sitterl e,2
N. Fauchet4 and E. Dannaoui1

Author address:

1Mycology, AP-HP, H^opital Europ een Georges Pompidou and
UMR BIPAR, Dynamyc, Paris, France; 2Mycology, APHP, H^opital
Henri Mondor, and UMR BIPAR, Dynamyc, Cr eteil, France; 3UMR
BIPAR, Dynamyc, Cr eteil, France and 4Parasitology-Mycology,
CHIC,

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Objectives Azole resistance in Aspergillus fumigatus is emerging in
Europe, particularly in the Netherlands and UK, but has also been
reported in several other European countries such as Austria, Bel-
gium, Denmark, France, Germany, Italy, and Sweden. In France,
although azole-resistance in clinical isolates has been detected more
than 10 years ago, the prevalence remains largely unknown.
The objective of the present study was to evaluate the prevalence
of azole resistance in A. fumigatus clinical isolates prospectively recov-
ered over a 1-year period (2012) at two centers in the same city,
near Paris.
Methods All isolates of A. fumigatus recovered over a period of
1 year (from January 2012 to December 2012) in clinical samples of
patients from two centers (H^opital Henri Mondor (HMN) and centre
hospitalier intercommunal Cr eteil (CHIC)) were prospectively identi-
fied and stored for subsequent analysis.
Isolates were revived from storage and in vitro susceptibility to
azoles was screened by subculturing each isolate on RPMI agar
plates supplemented with itraconazole (4 mg/L) and voriconazole
(1 mg/L). In vitro resistance was confirmed by the EUCAST refer-
ence method. EUCAST clinical breakpoints were used to categorize
the isolates. For patients with resistant isolates, clinical data includ-
ing underlying disease and previous exposure to azole drugs were
retrieved.
Results HMN and CHIC are tertiary hospitals with 805 and 509
beds, respectively. Both immunocompromized patients (hematological
malignancies, solid organ transplantations (liver, kidney and heart)),
and patients with chronic respiratory diseases including cystic fibrosis
are hospitalized in these centers.
During the study period, 1737 respiratory samples (sputum, bron-
chial fluid, BAL) were received at the laboratory for mycological cul-
tures. From these samples, 165 isolates of A. fumigatus were
recovered from 130 patients.
Three isolates highly resistant to azoles were recovered from 3
patients (Table). Evaluation of the mechanism of resistance involved
in these isolates is in progress.
Patient 1 was treated for an aspergilloma (excavated lesion in the
left apex) by voriconazole and surgery with a favorable outcome.

Patient 2 was colonized by A. fumigatus in a context of bacterial pul-
monary nodules treated by antibiotics. Patient 3 was successfully
treated by a combination of antibiotics and corticosteroids for ABPA
exacerbation.
Conclusions The present study demonstrated the occurrence of
azole resistance among unselected A. fumigatus clinical isolates, with
an overall prevalence of 1.8%. A larger multicenter study is war-
ranted to better characterize the prevalence of azole resistance in
France.

Abstract Number: p023

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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