Abstract

The prevalence and spread of azole resistance in clinical Aspergillus fumigatus isolates in the Netherlands are currently unknown. Therefore, we performed a prospective nationwide multicenter surveillance study to determine the effects of resistance on patient management strategies and public health. From June 2007 through January 2009, all clinical Aspergillus spp. isolates were screened for itraconazole resistance. In total, 2,062 isolates from 1,385 patients were screened; the prevalence of itraconazole resistance in A. fumigatus in our patient cohort was 5.3% (range 0.8%–9.5%). Patients with a hematologic or oncologic disease were more likely to harbor an azole-resistant isolate than were other patient groups (p<0.05). Most patients (64.0%) from whom a resistant isolate was identified were azole naive, and the case-fatality rate of patients with azole-resistant invasive aspergillosis was 88.0%. Our study found that multiazole resistance in A. fumigatus is widespread in the Netherlands and is associated with a high death rate for patients with invasive aspergillosis.

Highlights

  • This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases

  • Describe the prevalence of itraconazole resistance in clinical A. fumigatus isolates on the basis of a prospective, nationwide, multicenter surveillance study in the Netherlands

  • Describe risk factors for development of itraconazole resistance in A. fumigatus isolates on the basis of that study

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Summary

Introduction

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. LLC is accredited by the ACCME to provide continuing medical education for physicians. All other clinicians completing this activity will be issued a certificate of participation To participate in this journal CME activity: [1] review the learning objectives and author disclosures; [2] study the education content; [3] take the post-test with a 70% minimum passing score and complete the evaluation at www.medscape.org/journal/eid; [4] view/print certificate. Describe the prevalence of itraconazole resistance in clinical A. fumigatus isolates on the basis of a prospective, nationwide, multicenter surveillance study in the Netherlands. Describe risk factors for development of itraconazole resistance in A. fumigatus isolates on the basis of that study

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