A single-centre survey of invasive mould disease due to azole-resistant Aspergillus fumigatus in patients with haematological malignancies

P.P.A. Lestrade


Background: In  the Netherlands, surveillance  studies have reported azole resistant Aspergillusfumigatusrates of  4.3% to 15% based  on screening of unselected  isolates. We investigated  the implications of this phenomenon in patients who had been treated for a   haematological malignancy at the Radboud University Medical Centre.

Material/methods: The records from all  432 patients given chemotherapy for AML/MDS  or who had received an allogeneic HSCT between 2006  and 2012 were reviewed for  the presence of  invasive mould disease. All patients were  managed using  a    ‘diagnostic driven’  approach to invasive mould infections that included screening plasma for galactomannan twice-weekly and no  mould-active prophylaxis. Data were retrieved from the clinical records including the use of antifungal drugs, as well as radiology and microbiology reports and recorded on case report  forms (CRF).  Each CRF wasentered by FS, FB & AM into a   specially constructed database (PPL & JPD) to allow cases of possible, probable  or  proven invasive mould disease to be identified according  to the revised EORTC/MSGdefinitions (de Pauw et al, 2008 Clin Infect Dis 46: 1813-21) .  Each potential case independently and blindly reviewed by WvdV &  JPD and disputed cases were reviewed blindly by  PV. All remainingdiscrepancies were resolved by consensus (WvdV, JPD & PV).

Results: 182 (42%) of the432 patients had received chemotherapy for AML/MDS and the remainder had been given an allogeneic HSCT. Proven, probable and possible invasive mould disease affected, respectively, 5    (2.8%), 11 (6%) and 23 (12.6%) of patients  who had received chemotherapy and 5 (2.0%), 18 (7.2%) and 11 (4.4%) of recipients of an allogeneic HSCT. Azole-resistant A. fumigatuswas   recovered from sputum from 1 of 182 patient receiving chemotherapy and from sputum or BAL from 2 of 250  allogeneic HSCT recipients.  Diagnostic respiratory samples of  sputum and  BAL had been obtained from 49 (67%) of patients with  possible, probable or proven mould disease with Aspergillus fumigatusbeing  recovered  from 10 (20.4%)  of which only 1 isolate was azole-resistant.

Conclusions: The  frequency of azole-resistant Aspergillusfumigatus  was low  in this population though the exact incidence of azole resistant isolates  might be  different  had appropriate respiratory specimens been obtained from every patient with possible, probable or proven mould disease.Invasive moulddiseaseCasesRespiratory specimen obtainedAspergillus fumigatusrecoveredAzole resistantNone 35913112Possible 341900Probable 292381Proven 10730Total 43262223




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abstract No: 

    • ECCMID 26th (2016)