Antifungal susceptibilities of non-Aspergillus filamentous fungi causing invasive infection in Australia: support for current antifungal guideline recommendations

Halliday, Catriona; Chen, Sharon C.‐A.; Kidd, Sarah; Hal, Sebastian Van; Chapman, Belinda; Heath, Christopher H.; Lee, Andie; Kennedy, Karina; Daveson, Kathryn; Sorrell, Tania C.; Morrissey, C. Orla; Marriott, Deborah; Slavin, Monica A

doi:10.1016/j.ijantimicag.2016.07.005

Cited by 25 publications

(18 citation statements)

References 18 publications

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“…Ultimately, while we agree that the SYO microdilution panel offers a practical alternative to the reference (CLSI or EUCAST) method for antifungal susceptibility testing of molds (16), clinical microbiologists who use SYO in the routine setting, as we do, are required to compare the MIC mode and range data for each mold species tested in their own laboratory with the MIC distributions freely available on line or in the published literature (9). This would guarantee that MIC endpoints generated in the laboratory for each mold species would mirror those of the reference antifungal susceptibility testing methods and thus would be able to be correctly used for clinical purposes.…”

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confidence: 58%

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Susceptibility Testing of Common and Uncommon Aspergillus Species against Posaconazole and Other Mold-Active Antifungal Azoles Using the Sensititre Method

Mello

Posteraro

Vella

et al. 2017

Antimicrob Agents Chemother

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We tested 59 common and 27 uncommon Aspergillus species isolates for susceptibility to the mold-active azole antifungal agents itraconazole, voriconazole, and posaconazole using the Sensititre method. The overall essential agreement with the CLSI reference method was 96.5% for itraconazole and posaconazole and was 100% for voriconazole. By the Sensititre method as well as the CLSI reference method, all of 10 A. fumigatus isolates with a cyp51 mutant genotype were classified as being non-wild-type isolates (MIC Ͼ epidemiological cutoff value [ECV]) with respect to triazole susceptibility.KEYWORDS Aspergillus, Sensititre, antifungal susceptibility testing I n contrast to other but emerging molds (1), Aspergillus species, particularly Aspergillus fumigatus, remain the most common causes of invasive fungal diseases in both North America and Europe (2, 3). Because of the availability of (tri)azole antifungal agents, survival of immunocompromised patients with invasive aspergillosis has improved dramatically and could be further improved by optimizing antifungal treatments (4). A key component of this optimization should be the regular in vitro antifungal susceptibility testing of the patients' A. fumigatus isolates to detect azole resistance (5). Unfortunately, in most clinical microbiology laboratories, antifungal susceptibility testing of aspergilli (and other molds) is not routinely performed (6), thus underestimating the true prevalence of fungal resistance (4).The azole antifungal agents for clinical use include itraconazole, voriconazole, posaconazole, and, most recently, isavuconazole (7). Despite their role-unlike voriconazole, itraconazole and posaconazole are not approved as first-line agents-in treatment of invasive aspergillosis (4), the Clinical and Laboratory Standards Institute (CLSI) did not set clinical breakpoints (CBPs) for common Aspergillus species and mold-active triazoles, e.g., itraconazole and posaconazole (8), in contrast to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) (9). However, CLSI-based epidemiological cutoff values (ECVs) were established-instead of CBPs-for Aspergillus species (A. fumigatus, A. flavus, A. terreus, A. niger, A. nidulans, and A. versicolor) and for triazoles to aid in the early identification of clinical isolates with acquired resistance mechanisms (10, 11). Isolates of these six Aspergillus species for which triazole MICs exceed the ECV are considered to be non-wild type (non-WT) and may harbor mutations in the cyp51a gene-the best-known mechanism of triazole resistance in the A. fumigatus species-or other mutations (12). Interestingly, whereas the significance of ECVs in clinical practice needs to be understood, the ECVs defined to date-albeit mainly for Candida

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confidence: 58%

“…Whereas we have shown previously that the SYO microdilution panel-with which amphotericin B, echinocandins, and triazoles can be tested in parallel-is a reliable tool for antifungal resistance surveillance in Candida species (14), only limited data have been reported for Aspergillus (and other mold) species (15,16).…”

mentioning

confidence: 99%

Susceptibility Testing of Common and Uncommon Aspergillus Species against Posaconazole and Other Mold-Active Antifungal Azoles Using the Sensititre Method

Mello

Posteraro

Vella

et al. 2017

Antimicrob Agents Chemother

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“…311 VCZ is the most active agent in vitro against Scedosporium; 311,312 POSA and micafungin have moderate activity. 311,313 Significant interspecies differences in activity exist; S. prolificans is the most resistant species to medical therapy. 311,313 ECMM and European Society of Clinical Microbiology and Infectious Diseases guidelines recommend VCZ as the first-line therapy for scedosporiosis; surgical debridement or removal of affected tissue may be helpful as adjunctive therapy in some cases.…”

Section: Treatment Of Scedosporiosismentioning

confidence: 99%

Fungal Infections Complicating Lung Transplantation

Clark

Weigt

Fishbein³

et al. 2018

Semin Respir Crit Care Med

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Lung transplantation is an increasingly utilized modality for treating advanced lung disease. However, lung transplant recipients (LTRs) experience high rates of infection-related mortality and, compared with other solid organ transplant recipients, are at increased risk of infectious complications given the intensity of immunosuppression employed, the presence of airway abnormalities after surgery and exposure of the allograft to the environment. Fungal infections, particularly mold infections, are problematic after transplantation as they are often associated with limited treatment options and poor outcomes. We describe the non- fungal infections occurring in LTRs, including their epidemiology, clinical features, and treatment.

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“…Mortality rates of up to 90% are associated with these infections . Treatment of invasive infections is challenging as L prolificans isolates are often pan‐drug resistant, with elevated minimum inhibitory concentrations (MICs) against all available antifungal agents . More than 10 years ago, two relatively large studies reported that voriconazole was associated with survival rates between 44% and 66% and voriconazole was deemed the treatment of choice for invasive L prolificans infections .…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and outcomes of invasive Lomentospora prolificans infections: Analysis of patients in the FungiScope^® registry

Jenks

Seidel

Cornely

et al. 2020

Mycoses

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Objectives: Invasive fungal infections caused by Lomentospora prolificans are associated with very high mortality rates and can be challenging to treat given pan-drug resistance to available antifungal agents. The objective of this study was to describe the clinical presentation and outcomes in a cohort of patients with invasive L prolificans infections. Methods:We performed a retrospective review of medical records of patients with invasive L prolificans infection in the FungiScope ® registry of rare invasive fungal infections. Results:The analysis included 41 patients with invasive L prolificans infection from eight different countries. Haematological/oncological malignancies were the most frequent underlying disease (66%), disseminated infection was frequent (61%), and the lung was the most commonly involved organ (44%). Most infections (59%) were breakthrough infections. Progression/deterioration/treatment failure was observed in 23/40 (58%) of patients receiving antifungal therapy. In total, 21/41 (51%) patients, and 77% of patients with underlying haematological/oncological malignancy, had a fatal outcome attributed to invasive fungal infection. Combination antifungal therapy was frequent (24/40) and associated with improved survival. In particular, treatment regimens including terbinafine were significantly associated with higher treatment success at final assessment (P = .012), with a positive trend observed for treatment regimens that included voriconazole (P = .054). Conclusions:Lomentospora prolificans infections were associated with mortality rates of 77% and above in patients with underlying haematological/oncological malignancies and those with disseminated infections. While combination therapy is 438 |

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Antifungal susceptibilities of non-Aspergillus filamentous fungi causing invasive infection in Australia: support for current antifungal guideline recommendations

Cited by 25 publications

References 18 publications

Susceptibility Testing of Common and Uncommon Aspergillus Species against Posaconazole and Other Mold-Active Antifungal Azoles Using the Sensititre Method

Susceptibility Testing of Common and Uncommon Aspergillus Species against Posaconazole and Other Mold-Active Antifungal Azoles Using the Sensititre Method

Fungal Infections Complicating Lung Transplantation

Clinical characteristics and outcomes of invasive Lomentospora prolificans infections: Analysis of patients in the FungiScope^® registry

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Antifungal susceptibilities of non-Aspergillus filamentous fungi causing invasive infection in Australia: support for current antifungal guideline recommendations

Cited by 25 publications

References 18 publications

Susceptibility Testing of Common and Uncommon Aspergillus Species against Posaconazole and Other Mold-Active Antifungal Azoles Using the Sensititre Method

Susceptibility Testing of Common and Uncommon Aspergillus Species against Posaconazole and Other Mold-Active Antifungal Azoles Using the Sensititre Method

Fungal Infections Complicating Lung Transplantation

Clinical characteristics and outcomes of invasive Lomentospora prolificans infections: Analysis of patients in the FungiScope® registry

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Clinical characteristics and outcomes of invasive Lomentospora prolificans infections: Analysis of patients in the FungiScope^® registry