Azol-Resistenz bei Aspergillus fumigatus – Epidemiologie und Nachweis bei immunsupprimierten Patienten in Deutschland

Buchheidt, Dieter; Spieß, Birgit; Cornely, Oliver A.; Vehreschild, Maria J. G. T.; Hamprecht, Axel; Rath, Peter‐Michael; Steinmann, Jörg; Groß, Uwe; Bader, Oliver; Lauten, Melchior; Reinwald, Mark; Hofmann, W.-K.

doi:10.1055/s-0034-1370130

Cited by 2 publications

(2 citation statements)

References 14 publications

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“…Data on the epidemiology of azole-resistant A. fumigates isolates in patients with hematological cancer are scarce and may differ from country to country [Buchheidt et al 2014; Kidd et al 2015; Snelders et al 2008]. According to a recent prospective multicenter international surveillance study analyzing 3788 Aspergillus isolates in 22 centers from 19 countries, the prevalence of azole-resistant A. fumigatus was found to be 3.2% [van der Linden et al 2015].…”

Section: Diagnosismentioning

confidence: 99%

Recent developments in the management of invasive fungal infections in patients with oncohematological diseases

Ruhnke

Schwartz

2016

Therapeutic Advances in Hematology

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Patients with hematological cancer have a high risk of invasive fungal diseases (IFDs). These infections are mostly life threatening and an early diagnosis and initiation of appropriate antifungal therapy are essential for the clinical outcome. Most commonly, and species are involved. However, other non- molds are increasingly be identified in cases of documented IFDs. Important risk factors are long lasting granulocytopenia with neutrophil counts below 500/μl for more than 10 days or graft--host disease resulting from allogeneic stem-cell transplantation. For definite diagnosis of IFD, various diagnostic tools have to be applied, including conventional mycological culture and nonconventional microbiological tests such as antibody/antigen and molecular tests, as well as histopathology and radiology. In the last few years, various laboratory methods, like the GM immunoassay ( GM EIA), 1,3-ß-D-glucan (BG) assay or polymerase chain reaction (PCR) techniques have been developed for better diagnosis. Since no single indirect test, including radiological methods, provides the definite diagnosis of an invasive fungal infection, the combination of different diagnostic procedures, which include microbiological cultures, histological, serological and molecular methods like PCR together with the pattern of clinical presentation, may currently be the best strategy for the prompt diagnosis, initiation and monitoring of IFDs. Early start of antifungal therapy is mandatory, but clinical diagnostics often do not provide clear evidence of IFD. Integrated care pathways have been proposed for management and therapy of IFDs with either the diagnostic driven strategy using the preemptive antifungal therapy as opposed to the clinical or empirical driven strategy using the 'traditional' empirical antifungal therapy. Antifungal agents preferentially used for systemic therapy of invasive fungal infections are amphotericin B preparations, fluconazole, voriconazole, posaconazole, caspofungin, anidulafungin, micafungin, and most recently isavuconazole. Clinical decision making must consider licensing status, local experience and availability, pharmacological and economic aspects.

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Section: Diagnosismentioning

confidence: 99%

Recent developments in the management of invasive fungal infections in patients with oncohematological diseases

Ruhnke

Schwartz

2016

Therapeutic Advances in Hematology

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“…However, prolonged use of triazoles increases the likelihood of the development of drug resistance (4)(5)(6)(7)(8). Since the first report of itraconazole-resistant A. fumigatus in 1997, (6) azole-resistant A. fumigatus has been widely identified in clinical isolates from all over the world (4,(8)(9)(10)(11)(12)(13)(14)(15)(16). Meanwhile, azole-resistant A. fumigatus has also been discovered in the wild (16)(17)(18)(19).…”

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Multiple cyp51A -Based Mechanisms Identified in Azole-Resistant Isolates of Aspergillus fumigatus from China

Liu

Zeng

Zhang

et al. 2015

Antimicrob Agents Chemother

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e Seventy-two A. fumigatus clinical isolates from China were investigated for azole resistance based on mutations of cyp51A. We identified four azole-resistant strains, among which we found three strains highly resistant to itraconazole, two of which exhibit the TR34/L98H/S297T/F495I mutation, while one carries only the TR34/L98H mutation. To our knowledge, the latter has not been found previously in China. The fourth multiazole-resistant isolate (with only moderate itraconazole resistance) carries a new G432A mutation.

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Azol-Resistenz bei Aspergillus fumigatus – Epidemiologie und Nachweis bei immunsupprimierten Patienten in Deutschland

Cited by 2 publications

References 14 publications

Recent developments in the management of invasive fungal infections in patients with oncohematological diseases

Recent developments in the management of invasive fungal infections in patients with oncohematological diseases

Multiple cyp51A -Based Mechanisms Identified in Azole-Resistant Isolates of Aspergillus fumigatus from China

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