TY - JOUR
T1 - Paradoxal Trends in Azole-Resistant Aspergillus fumigatus in a National Multicenter Surveillance Program, the Netherlands, 2013-2018
AU - Lestrade, Pieter P.A.
AU - Buil, Jochem B.
AU - van der Beek, Martha T.
AU - Kuijper, E.J.
AU - van Dijk, K
AU - Kampinga, Greetje A.
AU - Rijnders, B.J.A.
AU - Vonk, Alieke
AU - Van Dissel, Jaap
AU - de Greeff, Sabine C.
AU - Schoffelen, Annelot F.
AU - Meis, Jacques F
AU - Verweij, Paul E.
AU - Melchers, Willem J. G.
N1 - Publisher Copyright: © 2020 Centers for Disease Control and Prevention (CDC). All rights reserved. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - We investigated the prevalence of azole resistance of AsÂpergillus fumigatus isolates in the Netherlands by screenAîng clinical A. fumigatus isolates for azole resistance during 2013-2018. We analyzed azole-resistant isolates phenoÂtypically by in vitro susceptibility testing and for the presAênce of resistance mutations in the Cyp51A gene. Over the 6-year period, 508 (11%) of 4, 496 culture-positive paÂtients harbored an azole-resistant isolate. Resistance freÂquency increased from 7.6% (95% CI 5.9%-9.8%) in 2013 (58/760 patients) to 14.7% (95% CI 12.3%-17.4%) in 2018 (112/764 patients) (p = 0.0001). TR34/L98H (69%) and TR46/Y121F/T289A (17%) accounted for 86% of Cyp51A mutaÂtions. However, the mean voriconazole MIC of TR34/L98H isolates decreased from 8 mg/L (2013) to 2 mg/L (2018), and the voriconazole-resistance frequency was 34% lower in 2018 than in 2013 (p = 0.0001). Our survey showed changing azole phenotypes in TR34/L98H isolates, which hampers the use of current PCR-based resistance tests.
AB - We investigated the prevalence of azole resistance of AsÂpergillus fumigatus isolates in the Netherlands by screenAîng clinical A. fumigatus isolates for azole resistance during 2013-2018. We analyzed azole-resistant isolates phenoÂtypically by in vitro susceptibility testing and for the presAênce of resistance mutations in the Cyp51A gene. Over the 6-year period, 508 (11%) of 4, 496 culture-positive paÂtients harbored an azole-resistant isolate. Resistance freÂquency increased from 7.6% (95% CI 5.9%-9.8%) in 2013 (58/760 patients) to 14.7% (95% CI 12.3%-17.4%) in 2018 (112/764 patients) (p = 0.0001). TR34/L98H (69%) and TR46/Y121F/T289A (17%) accounted for 86% of Cyp51A mutaÂtions. However, the mean voriconazole MIC of TR34/L98H isolates decreased from 8 mg/L (2013) to 2 mg/L (2018), and the voriconazole-resistance frequency was 34% lower in 2018 than in 2013 (p = 0.0001). Our survey showed changing azole phenotypes in TR34/L98H isolates, which hampers the use of current PCR-based resistance tests.
UR - http://www.scopus.com/inward/record.url?scp=85086832653&partnerID=8YFLogxK
U2 - https://doi.org/10.3201/eid2607.200088
DO - https://doi.org/10.3201/eid2607.200088
M3 - Article
C2 - 32568033
SN - 1080-6040
VL - 26
SP - 1447
EP - 1455
JO - Emerging infectious diseases
JF - Emerging infectious diseases
IS - 7
M1 - 32568033
ER -