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Volume 17, Number 10—October 2011

CME ACTIVITY

Clinical Implications of Azole Resistance in Aspergillus fumigatus, the Netherlands, 2007–2009

Jan W.M. van der LindenComments to Author , 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

Author affiliations: Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (J.W.M. van der Linden, E. Snelders, W.J.G. Melchers, P.E. Verweij); Groningen University Medical Centre, Groningen, the Netherlands (G.A. Kampinga); Erasmus Medical Centre, Rotterdam, the Netherlands (B.J.A. Rijnders); Utrecht University Medical Centre, Utrecht, the Netherlands (E. Mattsson); Vrije University Medical Centre, Amsterdam, the Netherlands (Y.J. Debets-Ossenkopp); Leiden University Medical Centre, Leiden, the Netherlands (E.J. Kuijper); Maastricht University Medical Centre, Maastricht, the Netherlands (F.H. van Tiel)

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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.
† 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.

*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.

*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.

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