International expert opinion on the management of infection caused by azole-resistant Aspergillus fumigatus

Paul E. Verweij*, Michelle Ananda-Rajah, David Andes, Maiken C. Arendrup, Roger J. Bruggemann, Anuradha Chowdhary, Oliver A. Cornely, David W. Denning, Andreas H. Groll, Koichi Izumikawa, Bart Jan Kullberg, Katrien Lagrou, Johan Maertens, Jacques F. Meis, Pippa Newton, Iain Page, Seyedmojtaba Seyedmousavi, Donald C. Sheppard, Claudio Viscoli, J. Peter DonnellyAafje Warris

*Corresponding author for this work

Research output: Contribution to journalLiterature review

145 Citations (Scopus)
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Abstract

An international expert panel was convened to deliberate the management of azole-resistant aspergillosis. In culture-positive cases, in vitro susceptibility testing should always be performed if antifungal therapy is intended. Different patterns of resistance are seen, with multi-azole and pan-azole resistance more common than resistance to a single triazole. In confirmed invasive pulmonary aspergillosis due to an azole-resistant Aspergillus, the experts recommended a switch from voriconazole to liposomal amphotericin B (L-AmB; Ambisome (R)). In regions with environmental resistance rates of >= 10%, a voriconazole-echinocandin combination or L-AmB were favoured as initial therapy. All experts recommended L-AmB as core therapy for central nervous system aspergillosis suspected to be due to an azole-resistant Aspergillus, and considered the addition of a second agent with the majority favouring flucytosine. Intravenous therapy with either micafungin or L-AmB given as either intermittent or continuous therapy was recommended for chronic pulmonary aspergillosis due to a pan-azole-resistant Aspergillus. Local and national surveillance with identification of clinical and environmental resistance patterns, rapid diagnostics, better quality clinical outcome data, and a greater understanding of the factors driving or minimising environmental resistance are areas where research is urgently needed, as well as the development of new oral agents outside the azole drug class. (C) 2015 The Authors. Published by Elsevier Ltd.

Original languageEnglish
Pages (from-to)30-40
Number of pages11
JournalDrug Resistance Updates
Volume21-22
DOIs
Publication statusPublished - 2015

Keywords

  • Azole resistance
  • Invasive aspergillosis
  • Chronic aspergillosis
  • Aspergillus fumigatus
  • Voriconazole
  • Chronic pulmonary aspergillosis
  • Central-nervous-system
  • Liposomal amphotericin-B
  • Pharmacodynamic Target Determination
  • Bronchoalveolar lavage fluid
  • Antifungal Therapy
  • TR34/L98H Mutations
  • CYP51A gene
  • Wild-type

Cite this

Verweij, P. E., Ananda-Rajah, M., Andes, D., Arendrup, M. C., Bruggemann, R. J., Chowdhary, A., ... Warris, A. (2015). International expert opinion on the management of infection caused by azole-resistant Aspergillus fumigatus. Drug Resistance Updates, 21-22, 30-40. https://doi.org/10.1016/j.drup.2015.08.001

International expert opinion on the management of infection caused by azole-resistant Aspergillus fumigatus. / Verweij, Paul E.; Ananda-Rajah, Michelle; Andes, David; Arendrup, Maiken C.; Bruggemann, Roger J.; Chowdhary, Anuradha; Cornely, Oliver A.; Denning, David W.; Groll, Andreas H.; Izumikawa, Koichi; Kullberg, Bart Jan; Lagrou, Katrien; Maertens, Johan; Meis, Jacques F.; Newton, Pippa; Page, Iain; Seyedmousavi, Seyedmojtaba; Sheppard, Donald C.; Viscoli, Claudio; Donnelly, J. Peter; Warris, Aafje.

In: Drug Resistance Updates, Vol. 21-22, 2015, p. 30-40.

Research output: Contribution to journalLiterature review

Verweij, PE, Ananda-Rajah, M, Andes, D, Arendrup, MC, Bruggemann, RJ, Chowdhary, A, Cornely, OA, Denning, DW, Groll, AH, Izumikawa, K, Kullberg, BJ, Lagrou, K, Maertens, J, Meis, JF, Newton, P, Page, I, Seyedmousavi, S, Sheppard, DC, Viscoli, C, Donnelly, JP & Warris, A 2015, 'International expert opinion on the management of infection caused by azole-resistant Aspergillus fumigatus', Drug Resistance Updates, vol. 21-22, pp. 30-40. https://doi.org/10.1016/j.drup.2015.08.001
Verweij, Paul E. ; Ananda-Rajah, Michelle ; Andes, David ; Arendrup, Maiken C. ; Bruggemann, Roger J. ; Chowdhary, Anuradha ; Cornely, Oliver A. ; Denning, David W. ; Groll, Andreas H. ; Izumikawa, Koichi ; Kullberg, Bart Jan ; Lagrou, Katrien ; Maertens, Johan ; Meis, Jacques F. ; Newton, Pippa ; Page, Iain ; Seyedmousavi, Seyedmojtaba ; Sheppard, Donald C. ; Viscoli, Claudio ; Donnelly, J. Peter ; Warris, Aafje. / International expert opinion on the management of infection caused by azole-resistant Aspergillus fumigatus. In: Drug Resistance Updates. 2015 ; Vol. 21-22. pp. 30-40.
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AU - Verweij, Paul E.

AU - Ananda-Rajah, Michelle

AU - Andes, David

AU - Arendrup, Maiken C.

AU - Bruggemann, Roger J.

AU - Chowdhary, Anuradha

AU - Cornely, Oliver A.

AU - Denning, David W.

AU - Groll, Andreas H.

AU - Izumikawa, Koichi

AU - Kullberg, Bart Jan

AU - Lagrou, Katrien

AU - Maertens, Johan

AU - Meis, Jacques F.

AU - Newton, Pippa

AU - Page, Iain

AU - Seyedmousavi, Seyedmojtaba

AU - Sheppard, Donald C.

AU - Viscoli, Claudio

AU - Donnelly, J. Peter

AU - Warris, Aafje

N1 - Acknowledgements We thank Gilead Sciences Europe Ltd., UK for financially supporting logistical aspects of this study. The logistics of the meeting were handled by Congress Care, Den Bosch, The Netherlands. The sponsor was not involved in the selection of the participants or procedures, or in the discussion, data collection, analysis or writing of the manuscript. The medical writer was financially supported by the Dutch Society for Medical Mycology and the Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.

PY - 2015

Y1 - 2015

N2 - An international expert panel was convened to deliberate the management of azole-resistant aspergillosis. In culture-positive cases, in vitro susceptibility testing should always be performed if antifungal therapy is intended. Different patterns of resistance are seen, with multi-azole and pan-azole resistance more common than resistance to a single triazole. In confirmed invasive pulmonary aspergillosis due to an azole-resistant Aspergillus, the experts recommended a switch from voriconazole to liposomal amphotericin B (L-AmB; Ambisome (R)). In regions with environmental resistance rates of >= 10%, a voriconazole-echinocandin combination or L-AmB were favoured as initial therapy. All experts recommended L-AmB as core therapy for central nervous system aspergillosis suspected to be due to an azole-resistant Aspergillus, and considered the addition of a second agent with the majority favouring flucytosine. Intravenous therapy with either micafungin or L-AmB given as either intermittent or continuous therapy was recommended for chronic pulmonary aspergillosis due to a pan-azole-resistant Aspergillus. Local and national surveillance with identification of clinical and environmental resistance patterns, rapid diagnostics, better quality clinical outcome data, and a greater understanding of the factors driving or minimising environmental resistance are areas where research is urgently needed, as well as the development of new oral agents outside the azole drug class. (C) 2015 The Authors. Published by Elsevier Ltd.

AB - An international expert panel was convened to deliberate the management of azole-resistant aspergillosis. In culture-positive cases, in vitro susceptibility testing should always be performed if antifungal therapy is intended. Different patterns of resistance are seen, with multi-azole and pan-azole resistance more common than resistance to a single triazole. In confirmed invasive pulmonary aspergillosis due to an azole-resistant Aspergillus, the experts recommended a switch from voriconazole to liposomal amphotericin B (L-AmB; Ambisome (R)). In regions with environmental resistance rates of >= 10%, a voriconazole-echinocandin combination or L-AmB were favoured as initial therapy. All experts recommended L-AmB as core therapy for central nervous system aspergillosis suspected to be due to an azole-resistant Aspergillus, and considered the addition of a second agent with the majority favouring flucytosine. Intravenous therapy with either micafungin or L-AmB given as either intermittent or continuous therapy was recommended for chronic pulmonary aspergillosis due to a pan-azole-resistant Aspergillus. Local and national surveillance with identification of clinical and environmental resistance patterns, rapid diagnostics, better quality clinical outcome data, and a greater understanding of the factors driving or minimising environmental resistance are areas where research is urgently needed, as well as the development of new oral agents outside the azole drug class. (C) 2015 The Authors. Published by Elsevier Ltd.

KW - Azole resistance

KW - Invasive aspergillosis

KW - Chronic aspergillosis

KW - Aspergillus fumigatus

KW - Voriconazole

KW - Chronic pulmonary aspergillosis

KW - Central-nervous-system

KW - Liposomal amphotericin-B

KW - Pharmacodynamic Target Determination

KW - Bronchoalveolar lavage fluid

KW - Antifungal Therapy

KW - TR34/L98H Mutations

KW - CYP51A gene

KW - Wild-type

U2 - 10.1016/j.drup.2015.08.001

DO - 10.1016/j.drup.2015.08.001

M3 - Literature review

VL - 21-22

SP - 30

EP - 40

JO - Drug Resistance Updates

JF - Drug Resistance Updates

SN - 1368-7646

ER -