Volume 17, Number 10—October 2011
CME ACTIVITY - Research
Clinical Implications of Azole Resistance in Aspergillus fumigatus, the Netherlands, 2007–2009
, Eveline Snelders, Greetje A. Kampinga, Bart J.A. Rijnders, Eva Mattsson, Yvette J. Debets-Ossenkopp, Ed J. Kuijper, Frank H. Van Tiel, Willem J.G. Melchers, Paul E. Verweij, and Kuijper
Table 4
Characteristics of patients with azole-resistant invasive aspergillosis, the Netherlands, 2007–2009*
| Patient age, y/sex | Underlying disease | Disease | No. positive cultures† | Resistance mechanism | VCZ MIC, mg/L | Prior azole treatment (duration)‡ | Treatment§ | Outcome at 12 wk |
|---|---|---|---|---|---|---|---|---|
| 66/M | Lung carcinoma | Proven pulmonary aspergillosis | 1 | TR/L98H | 4 | None | VCZ | Died |
| 59/M | Hematologic malignancy, allo-SCT, GvHD | Proven pulmonary aspergillosis | 4 | TR/L98H | 8 | VCZ (>1 mo) | VCZ | Died |
| 54/M | Acute myeloid leukemia, relapse, allo-HSCT | Proven pulmonary aspergillosis | 1 | TR/L98H | 8 | ITZ (2–4 wk) | VCZ | Died |
| 50/M | Non-Hodgkin lymphoma, allo-SCT, GvHD, lung cavities | Probable pulmonary aspergillosis | 2 | TR/L98H | 16 | VCZ (>1 mo) | VCZ | Died |
| 36/F | Breast carcinoma with metastasis | Probable pulmonary aspergillosis | 1 | TR/L98H | 1 | None | VCZ | Died |
| 13/F | Non-Hodgkin lymphoma | Proven pulmonary and CNS aspergillosis | 1 | TR/L98H | 16 | None | VCZ, CAS, AMB | Died |
| 58/M | Liver transplantation for hepatic failure after methotrexate treatment for arteritis | Proven pulmonary and CNS aspergillosis | 5 | TR/L98H | 2 | None | AMB, VCZ | Died |
| 60/M | Acute myeloid leukemia, allo-SCT, GvHD | Proven pulmonary and CNS aspergillosis | 3 | TR/L98H | 4 | FCZ (1–2 wk) | VCZ, CAS, AMB, POS | Survived
*VCZ, voriconazole; allo-SCT, allogeneic hematopoietic stem cell transplantation; GvHD, graft-versus-host disease; HSCT, hematopoietic stem cell transplantation; ITZ, itraconazole; CNS, central nervous system; CAS, caspofungin; AMB, amphotericin B; FCZ, fluconazole; POS, posaconazole. *VCZ, voriconazole; allo-SCT, allogeneic hematopoietic stem cell transplantation; GvHD, graft-versus-host disease; HSCT, hematopoietic stem cell transplantation; ITZ, itraconazole; CNS, central nervous system; CAS, caspofungin; AMB, amphotericin B; FCZ, fluconazole; POS, posaconazole. |
*VCZ, voriconazole; allo-SCT, allogeneic hematopoietic stem cell transplantation; GvHD, graft-versus-host disease; HSCT, hematopoietic stem cell transplantation; ITZ, itraconazole; CNS, central nervous system; CAS, caspofungin; AMB, amphotericin B; FCZ, fluconazole; POS, posaconazole.
† All cultures were Aspergillus fumigatus.
‡Azole treatment <12 wk before the first culturing of an azole-resistant isolate.
§Azole treatment after first culturing of resistant isolate.