title: Nationwide Surveillance of Azole Resistance in Aspergillus Diseases.
abstract: Aspergillus disease affects a broad patient population, from patients with asthma to immunocompromised patients. Azole resistance has been increasingly reported in both clinical and environmental Aspergillus strains. The prevalence and clinical impact of azole resistance in different patient populations are currently unclear. This 1-year prospective multicenter cohort study aimed to provide detailed epidemiological data on Aspergillus resistance among patients with Aspergillus disease in Belgium. Isolates were prospectively collected in 18 hospitals (April 2011 to April 2012) for susceptibility testing. Clinical and treatment data were collected with a questionnaire. The outcome was evaluated to 1 year after a patient's inclusion. A total of 220 Aspergillus isolates from 182 patients were included. The underlying conditions included invasive aspergillosis (n = 122 patients), allergic bronchopulmonary aspergillosis (APBA) (n = 39 patients), chronic pulmonary aspergillosis (n = 10 patients), Aspergillus bronchitis (n = 7 patients), and aspergilloma (n = 5 patients). The overall azole resistance prevalence was 5.5% (95% confidence interval [CI] 2.8 to 10.2%) and was 7.0% (4/57; 95% CI, 2.3 to 17.2%) in patients with APBA, bronchitis, aspergilloma, or chronic aspergillosis and 4.6% in patients with invasive aspergillosis (5/108; 95% CI, 1.7 to 10.7%). The 6-week survival in invasive aspergillosis was 52.5%, while susceptibility testing revealed azole resistance in only 2/58 of the deceased patients. The clinical impact of Aspergillus fumigatus resistance was limited in our patient population with Aspergillus diseases.
authors.affiliation: Department of Microbiology and Immunology, Catholic University Leuven, Leuven, Belgium.
authors.forename: Edith
authors.initials: E
authors.lastname: Vermeulen
authors.affiliation: Department of Microbiology and Immunology, Catholic University Leuven, Leuven, Belgium Department of Haematology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Maertens
authors.affiliation: Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
authors.forename: Annelies
authors.initials: A
authors.lastname: De Bel
authors.affiliation: Department of Microbiology, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium.
authors.forename: Eric
authors.initials: E
authors.lastname: Nulens
authors.affiliation: Department of Microbiology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Jerina
authors.initials: J
authors.lastname: Boelens
authors.affiliation: Department of Microbiology, Heilig Hart Ziekenhuis Roeselare-Menen, Roeselare, Belgium.
authors.forename: Ignace
authors.initials: I
authors.lastname: Surmont
authors.affiliation: Department of Microbiology, ZNA Hospitals Site Middelheim, Antwerp, Belgium.
authors.forename: Anna
authors.initials: A
authors.lastname: Mertens
authors.affiliation: Department of Clinical Microbiology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium.
authors.forename: An
authors.initials: A
authors.lastname: Boel
authors.affiliation: Department of Microbiology and Immunology, Catholic University Leuven, Leuven, Belgium National Reference Center for Mycosis, Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium katrien.lagrou@uzleuven.be.
authors.forename: Katrien
authors.initials: K
authors.lastname: Lagrou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy* / Q000453:epidemiology*; D001230:Aspergillus / Q000187:drug effects / Q000302:isolation & purification; D001393:Azoles / Q000627:therapeutic use*; D001530:Belgium / Q000453:epidemiology; D025141:Drug Resistance, Fungal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies
chemical_list: D000935:Antifungal Agents; D001393:Azoles