Report of three azole-resistant Aspergillus fumigatus cases with TR34/L98H mutation in hematological patients in Barcelona, Spain.

Autor: Monzo-Gallo P; Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Carrer de Villarroel 170, 08036, Barcelona, Spain. pmonzom@clinic.cat.; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain. pmonzom@clinic.cat., Alastruey-Izquierdo A; ISCIII, Instituto de Salud Carlos III, Madrid, Spain.; CIBERINFECT, Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain., Chumbita M; Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Carrer de Villarroel 170, 08036, Barcelona, Spain.; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain., Aiello TF; Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Carrer de Villarroel 170, 08036, Barcelona, Spain.; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain., Gallardo-Pizarro A; Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Carrer de Villarroel 170, 08036, Barcelona, Spain.; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain., Peyrony O; Emergency Department, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France., Teijon-Lumbreras C; Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Carrer de Villarroel 170, 08036, Barcelona, Spain., Alcazar-Fuoli L; ISCIII, Instituto de Salud Carlos III, Madrid, Spain.; CIBERINFECT, Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain., Espasa M; Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain., Soriano A; Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Carrer de Villarroel 170, 08036, Barcelona, Spain.; CIBERINFECT, Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain.; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain., Marco F; Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain., Garcia-Vidal C; Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Carrer de Villarroel 170, 08036, Barcelona, Spain. cgarciav@clinic.cat.; CIBERINFECT, Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Madrid, Spain. cgarciav@clinic.cat.; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain. cgarciav@clinic.cat.
Jazyk: angličtina
Zdroj: Infection [Infection] 2024 Oct; Vol. 52 (5), pp. 1651-1656. Date of Electronic Publication: 2024 May 27.
DOI: 10.1007/s15010-024-02236-7
Abstrakt: Objectives: We aimed to report the emergence of azole-resistant invasive aspergillosis in hematologic patients admitted to a tertiary hospital in Spain during the last 4 months.
Methods: Prospective, descriptive study was performed to describe and follow all consecutive proven and probable invasive aspergillosis resistant to azoles from hematological cohort during the last 4 months. All patients had fungal cultures and antifungal susceptibility or real-time PCR detection for Aspergillus species and real-time PCR detection for azole-resistant mutation.
Results: Four cases of invasive aspergillosis were diagnosed in 4 months. Three of them had azole-resistant aspergillosis. Microbiological diagnosis was achieved in three cases by means of fungal culture isolation and subsequent antifungal susceptibility whereas one case was diagnosed by PCR-based aspergillus and azole resistance detection. All the azole-resistant aspergillosis presented TR34/L98H mutation. Patients with azole-resistant aspergillosis had different hematologic diseases: multiple myeloma, lymphoblastic acute leukemia, and angioimmunoblastic T lymphoma. Regarding risk factors, one had prolonged neutropenia, two had corticosteroids, and two had viral co-infection. Two of the patients developed aspergillosis under treatment with azoles.
Conclusion: We have observed a heightened risk of azole-resistant aspergillosis caused by A. fumigatus harboring the TR 34 /L98H mutation in patients with hematologic malignancies. The emergence of azole-resistant aspergillosis raises concerns for the community, highlighting the urgent need for increased surveillance and the importance of susceptibility testing and new drugs development.
(© 2024. The Author(s).)
Databáze: MEDLINE
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