Nationwide Surveillance of Azole Resistance in Aspergillus Diseases

Abstract

ABSTRACTAspergillusdisease affects a broad patient population, from patients with asthma to immunocompromised patients. Azole resistance has been increasingly reported in both clinical and environmentalAspergillusstrains. The prevalence and clinical impact of azole resistance in different patient populations are currently unclear. This 1-year prospective multicenter cohort study aimed to provide detailed epidemiological data onAspergillusresistance among patients withAspergillusdisease in Belgium. Isolates were prospectively collected in 18 hospitals (April 2011 to April 2012) for susceptibility testing. Clinical and treatment data were collected with a questionnaire. The outcome was evaluated to 1 year after a patient's inclusion. A total of 220Aspergillusisolates from 182 patients were included. The underlying conditions included invasive aspergillosis (n= 122 patients), allergic bronchopulmonary aspergillosis (APBA) (n= 39 patients), chronic pulmonary aspergillosis (n= 10 patients),Aspergillusbronchitis (n= 7 patients), and aspergilloma (n= 5 patients). The overall azole resistance prevalence was 5.5% (95% confidence interval [CI] 2.8 to 10.2%) and was 7.0% (4/57; 95% CI, 2.3 to 17.2%) in patients with APBA, bronchitis, aspergilloma, or chronic aspergillosis and 4.6% in patients with invasive aspergillosis (5/108; 95% CI, 1.7 to 10.7%). The 6-week survival in invasive aspergillosis was 52.5%, while susceptibility testing revealed azole resistance in only 2/58 of the deceased patients. The clinical impact ofAspergillus fumigatusresistance was limited in our patient population withAspergillusdiseases.