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Multicenter Study
. 2015 Jun;21(6):1041-4.
doi: 10.3201/eid2106.140717.

Prospective multicenter international surveillance of azole resistance in Aspergillus fumigatus

J W M van der Linden, M C Arendrup, A Warris, K Lagrou, H Pelloux, P M Hauser, E Chryssanthou, E Mellado, S E Kidd, A M Tortorano, E Dannaoui, P Gaustad, J W Baddley, A Uekötter, C Lass-Flörl, N Klimko, C B Moore, D W Denning, A C Pasqualotto, C Kibbler, S Arikan-Akdagli, D Andes, J Meletiadis, L Naumiuk, M Nucci, W J G Melchers, P E Verweij
Multicenter Study

Prospective multicenter international surveillance of azole resistance in Aspergillus fumigatus

J W M van der Linden et al. Emerg Infect Dis. 2015 Jun.

Abstract

To investigate azole resistance in clinical Aspergillus isolates, we conducted prospective multicenter international surveillance. A total of 3,788 Aspergillus isolates were screened in 22 centers from 19 countries. Azole-resistant A. fumigatus was more frequently found (3.2% prevalence) than previously acknowledged, causing resistant invasive and noninvasive aspergillosis and severely compromising clinical use of azoles.

Keywords: Aspergillus; antimicrobial resistance; aspergillosis; azole resistance; fungi; international; prevalence; surveillance.

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Figures

Figure 1
Figure 1
Study characteristics (number of isolates/patients screened) from 22 centers in 19 countries participating in a study of azole resistance in Aspergillus fumigatus. *Period screened was 8 months instead of 1 year in this center for unknown reason. †Total number of screened patients is unknown because this center is a reference laboratory that does not have access to patient characteristics.
Figure 2
Figure 2
Patient characteristics and underlying resistance mechanisms of patients with invasive and noninvasive Aspergillus disease. *Otomycosis, dermatomycosis, or onychomycosis; 1 patient had a resistant isolate and otomycosis (patient 9 in the online Technical Appendix Table, http://wwwnc.cdc.gov/EID/article/21/6/14-0717-Techapp1.pdf). †One patient had chronic pulmonary aspergillosis and ABPA. ‡Not classified according to European Organization for the Research and Treatment of Cancer/Mycoses Study Group criteria (5). §One patient is included with 46-bp tandem-repeat resistance mechanism. ABPA, allergic bronchopulmonary aspergillosis; CPA, chronic pulmonary aspergillosis; R, resistant; S, susceptible; –, negative; +, positive.
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