title: Patterns of susceptibility of Aspergillus isolates recovered from patients enrolled in the Transplant-Associated Infection Surveillance Network.
abstract: We analyzed antifungal susceptibilities of 274 clinical Aspergillus isolates from transplant recipients with proven or probable invasive aspergillosis collected as part of the Transplant-Associated Infection Surveillance Network (TRANSNET) and examined the relationship between MIC and mortality at 6 or 12 weeks. Antifungal susceptibility testing was performed by the Clinical and Laboratory Standards Institute (CLSI) M38-A2 broth dilution method for amphotericin B (AMB), itraconazole (ITR), voriconazole (VOR), posaconazole (POS), and ravuconazole (RAV). The isolate collection included 181 Aspergillus fumigatus, 28 Aspergillus niger, 27 Aspergillus flavus, 22 Aspergillus terreus, seven Aspergillus versicolor, five Aspergillus calidoustus, and two Aspergillus nidulans isolates and two isolates identified as Aspergillus spp. Triazole susceptibilities were < or = 4 microg/ml for most isolates (POS, 97.6%; ITR, 96.3%; VOR, 95.9%; RAV, 93.5%). The triazoles were not active against the five A. calidoustus isolates, for which MICs were > or = 4 microg/ml. AMB inhibited 93.3% of isolates at an MIC of < or = 1 microg/ml. The exception was A. terreus, for which 15 (68%) of 22 isolates had MICs of >1 microg/ml. One of 181 isolates of A. fumigatus showed resistance (MIC > or = 4 microg/ml) to two of three azoles tested. Although there appeared to be a correlation of higher VOR MICs with increased mortality at 6 weeks, the relationship was not statistically significant (R2 = 0.61; P = 0.065). Significant relationships of in vitro MIC to all-cause mortality at 6 and 12 weeks for VOR or AMB were not found.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL 35294-0006, USA. jbaddley@uab.edu
authors.forename: John W
authors.initials: JW
authors.lastname: Baddley
authors.forename: Kieren A
authors.initials: KA
authors.lastname: Marr
authors.forename: David R
authors.initials: DR
authors.lastname: Andes
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
authors.forename: Carol A
authors.initials: CA
authors.lastname: Kauffman
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
authors.forename: James I
authors.initials: JI
authors.lastname: Ito
authors.forename: S Arunmozhi
authors.initials: SA
authors.lastname: Balajee
authors.forename: Peter G
authors.initials: PG
authors.lastname: Pappas
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Moser
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology*; D001228:Aspergillosis / Q000382:microbiology* / Q000401:mortality; D001230:Aspergillus / Q000187:drug effects* / Q000302:isolation & purification; D025141:Drug Resistance, Fungal; D006801:Humans; D016867:Immunocompromised Host; D008826:Microbial Sensitivity Tests; D014180:Transplantation / Q000009:adverse effects*
chemical_list: D000935:Antifungal Agents
references.citation: J Antimicrob Chemother. 2008 Mar;61(3):616-20
references.pmid: 18222957
references.citation: Antimicrob Agents Chemother. 2002 Apr;46(4):1032-7
references.pmid: 11897586
references.citation: J Clin Microbiol. 2005 Oct;43(10):5243-6
references.pmid: 16207990
references.citation: Antimicrob Agents Chemother. 2008 Oct;52(10):3504-11
references.pmid: 18644959
references.citation: Clin Infect Dis. 2008 Feb 1;46(3):327-60
references.pmid: 18177225
references.citation: J Antimicrob Chemother. 1998 Oct;42(4):497-502
references.pmid: 9818749
references.citation: Stud Mycol. 2007;59:39-46
references.pmid: 18490954
references.citation: Int J Antimicrob Agents. 2006 Nov;28(5):450-3
references.pmid: 17034993
references.citation: N Engl J Med. 2002 Dec 26;347(26):2173-4
references.pmid: 12501236
references.citation: Antimicrob Agents Chemother. 1997 Jun;41(6):1364-8
references.pmid: 9174200
references.citation: PLoS Med. 2008 Nov 11;5(11):e219
references.pmid: 18998768
references.citation: J Clin Microbiol. 2004 Aug;42(8):3475-82
references.pmid: 15297486
references.citation: Eukaryot Cell. 2008 Apr;7(4):630-8
references.pmid: 18281596
references.citation: J Clin Microbiol. 2008 Aug;46(8):2568-72
references.pmid: 18562581
references.citation: Med Mycol. 2010 Feb;48(1):97-102
references.pmid: 19296366
references.citation: Antimicrob Agents Chemother. 2002 Feb;46(2):556-7
references.pmid: 11796377
references.citation: Pharmacotherapy. 2005 Sep;25(9):1174-80
references.pmid: 16164392
references.citation: Antimicrob Agents Chemother. 2008 Sep;52(9):3444-6
references.pmid: 18606840
references.citation: N Engl J Med. 2007 Apr 5;356(14):1481-3
references.pmid: 17409336
references.citation: J Infect Dis. 2003 Jul 15;188(2):305-19
references.pmid: 12854088
references.citation: Clin Infect Dis. 2008 Nov 1;47(9):1176-84
references.pmid: 18808352
references.citation: Clin Infect Dis. 2002 Jan 1;34(1):7-14
references.pmid: 11731939
references.citation: Antimicrob Agents Chemother. 2004 Sep;48(9):3217-25
references.pmid: 15328076
references.citation: Clin Microbiol Rev. 2001 Oct;14(4):643-58, table of contents
references.pmid: 11585779
references.citation: Antimicrob Agents Chemother. 2008 Jul;52(7):2468-72
references.pmid: 18474574
references.citation: J Infect. 2000 Nov;41(3):203-20
references.pmid: 11120607
references.citation: J Clin Microbiol. 2004 Jul;42(7):3137-41
references.pmid: 15243072
references.citation: Clin Infect Dis. 2007 Feb 15;44(4):531-40
references.pmid: 17243056
references.citation: Br J Haematol. 2005 Oct;131(2):201-7
references.pmid: 16197450