title: In vitro susceptibility to amphotericin B, itraconazole, voriconazole, posaconazole and caspofungin of Aspergillus spp. isolated from patients with haematological malignancies in Tunisia.
abstract: The resistance of Aspergillus species to antifungal is increasingly reported and the knowledge of the local epidemiology and antifungal susceptibility pattern is pivotal to define adequate treatment policies. Our study aimed to: 1) describe the in vitro antifungal susceptibility profile of the Aspergillus species isolated from patients with haematological malignancies in Tunisia; 2) compare the E-test and Sensititre Yeast-One assays for the detection of paradoxical growth and trailing effect, both phenotypes commonly exhibited by Aspergillus spp. upon exposure to caspofungin and 3) to evaluate the mortality rate in patients according to the causative Aspergillus species and the antifungal treatment. We tested amphotericin B, itraconazole, voriconazole, posaconazole and caspofungin against 48 Aspergillus isolates (17, A. niger; 18, A. flavus; 9, A. tubingensis; 1, A. westerdijkiae; and 1, A. ochraceus) with the E-test. Minimal inhibition concentrations were above the epidemiological cut-off values for amphotericin B in 67% of A. flavus strains; for caspofungin in 22% of A. flavus strains; and for itraconazole in 22% of A. tubingensis strains, voriconazole and posaconazole MICs were below the epidemiological cut-off values for all strains. When exposed to caspofungin, 42% of the strains exhibited trailing effect and 38% paradoxical growth. Trailing effect occurred in 61% of A. flavus strains and paradoxical growth in 62% of Aspergillus section Nigri strains. E-test and Sensititre Yeast-One assays were only fairly concordant for the detection of these phenotypes. Repeatability of both assays was high for trailing effect but poor for paradoxical growth. The relatively high frequency of amphotericin B resistant strains makes voriconazole best adapted as a first-line treatment of invasive aspergillosis from amphotericin B to voriconazole in this hospital.
authors.affiliation: Service d'Hygiène Hospitalière, CHU Farhat Hached, Sousse, 4000 Tunisie ; Unité de recherche UR 04SP24, Ministère de la Santé Publique, Tunis, Tunisie ; Laboratoire de Parasitologie -Mycologie, CHU Farhat Hached, Sousse, 4000 Tunisie.
authors.forename: Soukeina
authors.initials: S
authors.lastname: Gheith
authors.affiliation: Unité de recherche UR 04SP24, Ministère de la Santé Publique, Tunis, Tunisie.
authors.forename: Fatma
authors.initials: F
authors.lastname: Saghrouni
authors.affiliation: Service d'Hygiène Hospitalière, CHU Farhat Hached, Sousse, 4000 Tunisie.
authors.forename: Wadiaa
authors.initials: W
authors.lastname: Bannour
authors.affiliation: Service d'Hématologie Clinique, CHU Farhat Hached, Sousse, Tunisie.
authors.forename: Yosra
authors.initials: Y
authors.lastname: Ben Youssef
authors.affiliation: Service d'Hématologie Clinique, CHU Farhat Hached, Sousse, Tunisie.
authors.forename: Abderrahim
authors.initials: A
authors.lastname: Khelif
authors.affiliation: Parasitology & Mycology, CHU Timone-Adultes, Assistance Publique-Hôpitaux de Marseille, Marseille, 13005 France ; Aix-Marseille Université, IP-TPT UMR MD3, Marseille, 13885 France.
authors.forename: Anne-Cécile
authors.initials: AC
authors.lastname: Normand
authors.affiliation: Parasitology & Mycology, CHU Timone-Adultes, Assistance Publique-Hôpitaux de Marseille, Marseille, 13005 France ; Aix-Marseille Université, IP-TPT UMR MD3, Marseille, 13885 France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Piarroux
authors.affiliation: Unité de recherche UR 04SP24, Ministère de la Santé Publique, Tunis, Tunisie.
authors.forename: Moncef
authors.initials: M
authors.lastname: Ben Said
authors.affiliation: Service d'Hygiène Hospitalière, CHU Farhat Hached, Sousse, 4000 Tunisie ; Unité de recherche UR 04SP24, Ministère de la Santé Publique, Tunis, Tunisie.
authors.forename: Mansour
authors.initials: M
authors.lastname: Njah
authors.affiliation: Parasitology & Mycology, CHU Timone-Adultes, Assistance Publique-Hôpitaux de Marseille, Marseille, 13005 France ; Aix-Marseille Université, IP-TPT UMR MD3, Marseille, 13885 France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ranque
keywords: Amphotericin B; Antifungal drugs; Aspergillus; Caspofungin; Haematological malignancies; In vitro susceptibility; In vitro susceptibility testing; Invasive aspergillosis; Itraconazole; MIC; Paradoxical growth; Posaconazole; Trailing effect; Voriconazole