A prospective survey of Aspergillus spp. in respiratory tract samples: prevalence, clinical impact and antifungal susceptibility

• Published in: European journal of clinical microbiology & infectious diseases Vol. 30; no. 11; pp. 1355 - 1363
• Main Authors: Mortensen, K. L., Johansen, H. K., Fuursted, K., Knudsen, J. D., Gahrn-Hansen, B., Jensen, R. H., Howard, S. J., Arendrup, M. C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-11-2011; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Allergic bronchopulmonary aspergillosis; Amphotericin B; Amphotericin B - pharmacology; Amphotericin B - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antifungal agents; Antifungal Agents - pharmacology; Antifungal Agents - therapeutic use; Aspergillosis; Aspergillosis - diagnosis; Aspergillosis - drug therapy; Aspergillosis - epidemiology; Aspergillosis - microbiology; Aspergillus; Aspergillus - drug effects; Aspergillus - isolation & purification; azoles; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Child; Child, Preschool; Chronic obstructive pulmonary disease; Cystic fibrosis; Denmark - epidemiology; Drug Resistance, Fungal - drug effects; Epidemiology; Female; Hematology; Hospitals; Human mycoses; Humans; Infectious diseases; Intensive care; Intensive care units; Internal Medicine; Itraconazole; Itraconazole - pharmacology; Itraconazole - therapeutic use; Laboratories; Male; Medical Microbiology; Medical sciences; Microbial Sensitivity Tests; Microbiology; Middle Aged; Minimum inhibitory concentration; Miscellaneous mycoses; Mycoses; Pathogens; Pharmacology. Drug treatments; Posaconazole; Prevalence; Prospective Studies; Pyrimidines - pharmacology; Pyrimidines - therapeutic use; Respiratory System - microbiology; Respiratory tract; Respiratory Tract Infections - diagnosis; Respiratory Tract Infections - drug therapy; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - microbiology; Stem cells; Steroid hormones; Transplants & implants; Treatment Outcome; Triazoles - pharmacology; Triazoles - therapeutic use; Voriconazole; Denmark; Aarhus Denmark; Azole; Chronic Obstructive Pulmonary Disease; Voriconazole; Aspergillosis; Itraconazole; Prevalence; Mycosis; Microbiology; Epidemiology; Fungi; Infection; Respiratory tract; Aspergillus; Antifungal agent; Survey; Bronchoalveolar lavage; Sputum; Fungi Imperfecti
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-011-1229-7

A three-month laboratory-based prospective survey was conducted at four major university hospitals covering one-third of the Danish population in order to determine the prevalence, significance, and susceptibility pattern of aspergilli in airway samples. Samples received in January–March 2007 for routine microbiologic investigation were examined for
Aspergillus
following routine procedures and with extended incubation (5 days). Identification was done by morphologic criteria and susceptibility testing using EUCAST method for azoles and amphotericin B E-test. Invasive aspergillosis (IA) was evaluated using modified EORTC/MSG criteria. A total of 11,368 airway samples were received. Growth of
Aspergillus
spp. was found in 129 and 151 patients using routine and extended incubation, respectively. Three patients had proven IA (2%), 11 probable (7%), four had allergic bronchopulmonary aspergillosis (ABPA) (3%), but the majority was colonised (88%). Underlying conditions were cystic fibrosis in 82 patients (55%), chronic obstructive pulmonary disease in 19 (13%) and haematological disorder in 11 (7%). Twenty-six patients (18%) were at intensive care unit and 69 (47%) received steroid treatment. Azole MICs were elevated for five isolates as follows (itraconazole, posaconazole, voriconazole MICs [mg/L]): two
A. fumigatus
isolates (>4; >4; 2 and >4; 0.125; 1), one
A. lentulus
isolate (2; 2; 0.5) and two
A. terreus
isolates (2; 2; 2 and 2; 0.125; 1). For four isolates the amphotericin B MIC was >1 μg/ml (3/112
A. fumigatus
, 1/2
A. terreus
). In conclusion,
Aspergillus
appears to be an important pathogen in Denmark. Elevated itraconazole MICs were detected in 4% of the isolates including a multi-azole resistant isolate.