The diagnosis and treatment of invasive aspergillosis in Dutch haematology units facing a rapidly increasing prevalence of azole-resistance. A nationwide survey and rationale for the DB-MSG 002 study protocol

Alexander F.A.D. Schauwvlieghe, Nick de Jonge, Karin van Dijk, Paul E. Verweij, Roger J. Brüggemann, Bart J. Biemond, Aldert Bart, Peter A. von dem Borne, Annelies Verbon, Martha T. van der Beek, Astrid M.P. Demandt, Guy J. Oudhuis, Jan J. Cornelissen, Walter J.F.M. van der Velden, Lambert F.R. Span, Greetje A. Kampinga, Anke H. Bruns, Alieke G. Vonk, Pieter–Jan A. Haas, Jeanette K. DoorduijnBart J.A. Rijnders

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)

Abstract

Patients with haematological malignancies are at risk for invasive fungal diseases (IFD). A survey was conducted in all Dutch academic haematology centres on their current diagnostic, prophylactic and therapeutic approach towards IFD in the context of azole-resistance. In all 8 centres, a haematologist and microbiologist filled in the questionnaire that focused on different subgroups of haematology patients. Fungal prophylaxis during neutropaenia was directed against Candida and consisted of fluconazole and/or amphotericin B suspension. Mould-active prophylaxis was given to acute myeloid leukaemia patients during chemotherapy in 2 of 8 centres. All centres used azole prophylaxis in a subset of patients with graft-versus-host disease. A uniform approach towards the diagnosis and treatment of IFD and in particular azole-resistant Aspergillus fumigatus was lacking. In 2017, all centres agreed to implement a uniform diagnostic and treatment algorithm regarding invasive aspergillosis with a central role for comprehensive diagnostics and PCR-based detection of azole-resistance. This study (DB-MSG 002) will re-evaluate this algorithm when 280 patients have been treated. A heterogeneous approach towards antifungal prophylaxis, diagnosis and treatment was apparent in the Netherlands. Facing triazole-resistance, consensus was reached on the implementation of a uniform diagnostic approach in all 8 centres.

Original languageEnglish
Pages (from-to)656-664
Number of pages9
JournalMycoses
Volume61
Issue number9
DOIs
Publication statusPublished - Sept 2018
Externally publishedYes

Keywords

  • azole-resistance
  • IFD
  • invasive aspergillosis
  • management

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