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Volume 17, Number 10—October 2011

CME ACTIVITY

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

Earning MEDSCAPE CME Credit

To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions (with a minimum 70% passing score) and earn continuing medical education (CME) credit, please go to www.medscape.org/journal/eid. Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers. You must be a registered user on Medscape.org. If you are not registered on Medscape.org, please click on the New Users: Free Registration link on the left hand side of the website to register. Only one answer is correct for each question. Once you successfully answer all post-test questions you will be able to view and/or print your certificate. For questions regarding the content of this activity, contact the accredited provider, CME@medscape.net. For technical assistance, contact CME@webmd.net. American Medical Association’s Physician’s Recognition Award (AMA PRA) credits are accepted in the US as evidence of participation in CME activities. For further information on this award, please refer to http://www.ama-assn.org/ama/pub/category/2922.html. The AMA has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credits™. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit may be acceptable as evidence of participation in CME activities. If you are not licensed in the US, please complete the questions online, print the certificate and present it to your national medical association for review.

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

MEDSCAPE CME Questions

1. Which of the following statements about the prevalence of itraconazole resistance in clinical Aspergillus fumigatus isolates is most likely correct?

A. Overall prevalence was 5.3%

B. Resistant isolates were found in half of participating university medical centers

C. The range of prevalence at participating university medical centers was 0%–6%

D. One quarter of azole-resistant isolates had the TR/L98H mutation in the Cyp51A gene

2. A 34-year-old white woman presents with non-Hodgkin lymphoma, pulmonary symptoms, and positive sputum culture for A. fumigatus. On the basis of the study by van der Linden and colleagues, which of the following statements about risk factors for development of itraconazole resistance in A. fumigatus isolates is most likely correct?

A. History of a hematologic/oncologic disease is not a risk factor

B. Previous azole treatment is necessary for development of resistance

C. Most TR/L98H mutations are resistant to voriconazole and have a narrow range of minimum inhibitory concentrations

D. Azole resistance may develop in patients with cavitary lung lesions such as aspergilloma

3. Which of the following statements about outcomes associated with development of itraconazole resistance in A. fumigatus isolates is most likely to apply to the previously described patient?

A. The mortality rate of patients with azole-resistant invasive aspergillosis is ≈50%

B. Two thirds of patients whose treatment was switched to another class of antifungal survived

C. None of the patients who were treated with voriconazole monotherapy were alive at 3 months

D. This study proved that azole resistance causes poor clinical outcomes in patients with azole-resistant aspergillosis

Activity Evaluation

1. The activity supported the learning objectives.

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2. The material was organized clearly for learning to occur.

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3. The content learned from this activity will impact my practice.

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4. The activity was presented objectively and free of commercial bias.

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