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
- ECCMID 26th (2016)