The current state of laboratory mycology and access to antifungal treatment in Europe: a European Confederation of Medical Mycology survey

Salmanton‐García, Jon; Hoenigl, Martin; Gangneux, Jean‐Pierre; Segal, Esther; Alastruey‐Izquierdo, Ana; Akdağlı, Sevtap Arıkan; Lagrou, Katrien; Özenci, Volkan; Vena, Antonio; Cornely, Oliver A.

doi:10.1016/s2666-5247(22)00261-0

Cited by 50 publications

(48 citation statements)

References 37 publications

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“…and Mucorales were only mentioned in two. This is in line with the data previously described for Europe in general, 16 as well as with the recently published World Health Organization (WHO) priority list of fungal pathogens, where certain Aspergillus spp. and Candida spp.…”

Section: Discussionsupporting

confidence: 91%

“…Although some tests are not available in all institutions, there is always at least one test that allows timely diagnosis of the most common invasive fungal infections 18–29 . Nevertheless, it should be noted that all Austrian hospitals are above the European average for each of the parameters analysed, both for diagnosis and treatment 16 . This puts Austria in one of the best situations to fight invasive fungal infections properly.…”

Section: Discussionmentioning

confidence: 99%

“…[18][19][20][21][22][23][24][25][26][27][28][29] Nevertheless, it should be noted that all Austrian hospitals are above the European average for each of the parameters analysed, both for diagnosis and treatment. 16 This puts Austria in one of the best situations to fight invasive fungal infections properly. The analysed institutions not only have access to all diagnostic tests described as essential by the WHO, but also go beyond such a list.…”

Section: Discussionmentioning

confidence: 99%

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The Austrian landscape of diagnostic capacity and access to treatment for invasive fungal infections

Salmanton‐García,

Hoenigl,

Salzer

et al. 2023

Mycoses

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IntroductionImmunosuppression after chemotherapy, stem cell transplantation or solid organ transplantation are the main risk factors for invasive fungal infections in Austria. Here, we aim to describe the status of laboratory mycology and the access to antifungal treatment in Austria.MethodsBetween October and November 2021, hospitals were contacted to participate in our online survey: www.clinicalsurveys.net/uc/IFI_management_capacity/. Centres were required to provide information on their institutional profile; self‐assessment of burden of invasive fungal infections; access to microscopy, culture, serology, antigen detection and molecular testing; and availability of antifungal agents and therapeutic drug monitoring.ResultsResponses were collected from university hospitals and laboratories in Graz, Innsbruck, Linz and Vienna. The four hospitals can provide tertiary care and were highly specialised, including management of patients with severe immunosuppression. All sites consider the incidence of invasive fungal infections to be moderate. Access to microscopy, culture, serology, antigen detection and molecular testing is provided regardless of laboratory. The maximum capacity to identify fungi varies from institution to institution. All currently marketed antifungal agents are available at the four sites.ConclusionAustria is currently well equipped to deal with the emerging threat of invasive fungal infections. However, hospitals may consider preparing for the potential endemicity of certain infections in the near future.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Austrian landscape of diagnostic capacity and access to treatment for invasive fungal infections

Salmanton‐García,

Hoenigl,

Salzer

et al. 2023

Mycoses

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“…Approximately two-thirds of European microbiology laboratories have access to in vitro susceptibility testing for molds. 55 However, Aspergillus culture has a low sensitivity in hematology patients with acute IPA and in patients with chronic Aspergillus diseases. 45 Although Aspergillus and azole resistance can be detected with commercial PCR assays, only TR-mediated mutations can be identified.…”

Section: Resistance Management and Antifungal Stewardshipmentioning

confidence: 99%

Antifungal Resistance in Pulmonary Aspergillosis

Verweij,

Song,

Buil

et al. 2024

Semin Respir Crit Care Med

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Aspergilli may cause various pulmonary diseases in humans, including allergic bronchopulmonary aspergillosis (ABPA), chronic pulmonary aspergillosis (CPA), and acute invasive pulmonary aspergillosis (IPA). In addition, chronic colonization may occur in cystic fibrosis (CF). Aspergillus fumigatus represents the main pathogen, which may employ different morphotypes, for example, conidia, hyphal growth, and asexual sporulation, in the various Aspergillus diseases. These morphotypes determine the ease by which A. fumigatus can adapt to stress by antifungal drug exposure, usually resulting in one or more resistance mutations. Key factors that enable the emergence of resistance include genetic variation and selection. The ability to create genetic variation depends on the reproduction mode, including, sexual, parasexual, and asexual, and the population size. These reproduction cycles may take place in the host and/or in the environment, usually when specific conditions are present. Environmental resistance is commonly characterized by tandem repeat (TR)-mediated mutations, while in-host resistance selection results in single-resistance mutations. Reported cases from the literature indicate that environmental resistance mutations are almost exclusively present in patients with IA indicating that the risk for in-host resistance selection is very low. In aspergilloma, single-point mutations are the dominant resistance genotype, while in other chronic Aspergillus diseases, for example, ABPA, CPA, and CF, both TR-mediated and single-resistance mutations are reported. Insights into the pathogenesis of resistance selection in various Aspergillus diseases may help to improve diagnostic and therapeutic strategies.

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“…These statistics highlight the critical importance that candidiasis has in human disease. One of the critical factors in managing these infections is our ability, or lack thereof, to successfully diagnose these infections (12).…”

mentioning

confidence: 99%

Our current clinical understanding of Candida biofilms: where are we two decades on?

Ramage

Borghi

Rodrigues

et al. 2023

APMIS

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Clinically we have been aware of the concept of Candida biofilms for many decades, though perhaps without the formal designation. Just over 20 years ago the subject emerged on the back of progress made from the bacterial biofilms, and academic progress pace has continued to mirror the bacterial biofilm community, albeit at a decreased volume. It is apparent that Candida species have a considerable capacity to colonize surfaces and interfaces and form tenacious biofilm structures, either alone or in mixed species communities. From the oral cavity, to the respiratory and genitourinary tracts, wounds, or in and around a plethora of biomedical devices, the scope of these infections is vast. These are highly tolerant to antifungal therapies that has a measurable impact on clinical management. This review aims to provide a comprehensive overight of our current clinical understanding of where these biofilms cause infections, and we discuss existing and emerging antifungal therapies and strategies.

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The current state of laboratory mycology and access to antifungal treatment in Europe: a European Confederation of Medical Mycology survey

Cited by 50 publications

References 37 publications

The Austrian landscape of diagnostic capacity and access to treatment for invasive fungal infections

The Austrian landscape of diagnostic capacity and access to treatment for invasive fungal infections

Antifungal Resistance in Pulmonary Aspergillosis

Our current clinical understanding of Candida biofilms: where are we two decades on?

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