Positive Aspergillus PCR as a marker of azole resistance or sub-therapeutic antifungal therapy in patients with chronic pulmonary aspergillosis

被引:8
作者
Moazam, Samihah [1 ,2 ]
Eades, Christopher Philip [1 ,2 ]
Muldoon, Eavan Gabrielle [1 ,2 ]
Moore, Caroline B. [2 ,3 ]
Richardson, Malcolm D. [2 ,3 ]
Rautemaa-Richardson, Riina [1 ,2 ,3 ]
机构
[1] Wythenshawe Hosp, Manchester Univ NHS Fdn Trust, Natl Aspergillosis Ctr, Manchester, Lancs, England
[2] Univ Manchester, Div Infect Inflammat & Resp Med, Fac Biol Med & Hlth, Manchester, Lancs, England
[3] Wythenshawe Hosp, Manchester Univ NHS Fdn Trust, ECMM Ctr Mycol Excellence, Mycol Reference Ctr Manchester, Manchester, Lancs, England
关键词
antifungal resistance; Aspergillus fumigatus; azoles; polymerase chain reaction; ITRACONAZOLE; FUMIGATUS;
D O I
10.1111/myc.13052
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
Background Chronic pulmonary aspergillosis (CPA) is a progressive respiratory disease, caused most commonly by A fumigatus, with significant morbidity and mortality. Azole resistance in A fumigatus is a growing concern worldwide, with resistance to itraconazole reported in up to 50% of patients. Aim The aim of this study was to determine whether a positive Aspergillus PCR (polymerase chain reaction) is a marker of resistance in CPA patients on azole therapy. Methods Patients were selected via a consecutive database search for the first 50 CPA patients with a positive Aspergillus PCR from January to September 2016. Data were collected regarding concurrent and subsequent culture results, current therapy and serum antifungal levels. PCR-positive patients not on therapy were included as the control group. Results Twenty-three patients were on therapy (15 itraconazole, 4 voriconazole and 4 posaconazole). Cycle threshold (Ct) values ranged from 20.8 to 37.9; no significant difference was found between each treatment and the control group (P = .47). In treated patients, concurrent azole-resistant A fumigatus was found in 75% of A fumigatus-positive cultures (6/8). All of the resistant isolates in the itraconazole group showed therapy resistance. Twenty per cent of all itraconazole levels were sub-therapeutic. No significant difference was found in serum itraconazole levels for patients on itraconazole with a positive PCR versus negative PCR (P = .44). Conclusion Positive sputum, Aspergillus-specific PCR can be associated with azole resistance in CPA patients on therapy.
引用
收藏
页码:376 / 381
页数:6
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