Aspergillus terreus: an emerging amphotericin B-resistant opportunistic mold in patients with hematologic malignancies.
BACKGROUND
Invasive aspergillosis (IA) has emerged as a common cause of morbidity and mortality among immunocompromised patients. At The University of Texas M. D. Anderson Cancer Center (Houston, TX), Aspergillus terreus is second to A. fumigatus as the most common cause of IA. In the current study, the authors compared the risk factors and outcomes associated with IA caused by A. terreus and IA caused by A. fumigatus.


METHODS
The authors retrospectively reviewed the medical records of 300 patients who received care at our institution between 1995 and 2001 and who had cultures that were positive for Aspergillus infection, including 90 patients whose cultures were positive for A. fumigatus and 70 patients whose cultures were positive for A. terreus.


RESULTS
Thirty-two patients with IA caused by A. terreus and 33 patients with IA caused by A. fumigatus were evaluated. The two groups were comparable in terms of age, gender, and underlying disease. Leukemia was the most common underlying malignancy (84%). More than 40% of patients in each group had undergone bone marrow transplantation. There was a trend toward a higher frequency of neutropenia among patients with IA caused by A. terreus (P = 0.12). IA caused by A. terreus was considered to be nosocomial in origin significantly more frequently compared with IA caused by A. fumigatus (P = 0.03). In vitro, A. terreus was found to be more resistant to amphotericin B (minimal inhibitory concentration [MIC90], 4.0 microg/mL) than to antifungal therapy (MIC90, 1.0 Hg/mL) in the isolates that were tested (< 50% of all isolates). The overall rate of response to antifungal therapy was 39% for patients with A. fumigatus infection, compared with 28% for patients with A. terreus infection (P = 0.43).


CONCLUSIONS
Despite the decreased in vitro susceptibility of A. terreus (relative to A. fumigatus) to amphotericin B, the two groups within the current patient population had comparably poor responses to amphotericin B preparation and somewhat improved responses to posaconazole.
Hachem
Ray Y
RY
Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston 77030, USA. rhachem@mdanderson.org
Kontoyiannis
Dimitrios P
DP
Boktour
Maha R
MR
Afif
Claude
C
Cooksley
Catherine
C
Bodey
Gerald P
GP
Chatzinikolaou
Ioannis
I
Perego
Cheryl
C
Kantarjian
Hagop M
HM
Raad
Issam I
II
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000494:pharmacology* / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000382:microbiology; D001230:Aspergillus / Q000187:drug effects*; D001232:Aspergillus fumigatus / Q000187:drug effects; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D025141:Drug Resistance, Fungal; D005260:Female; D006801:Humans; D007938:Leukemia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications; D009894:Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014230:Triazoles / Q000627:therapeutic use
D014230:Triazoles; C101425:posaconazole; D000666:Amphotericin B