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Abstract
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 if 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 -September 2016. Data was 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 20.8-37.9; no significant difference was found between each treatment and the control group (P =0.47). 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 =0.44).
Conclusion: Positive sputum, Aspergillus-specific PCR can be associated with azole resistance in CPA patients on therapy.
Aim: The aim of this study was to determine if 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 -September 2016. Data was 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 20.8-37.9; no significant difference was found between each treatment and the control group (P =0.47). 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 =0.44).
Conclusion: Positive sputum, Aspergillus-specific PCR can be associated with azole resistance in CPA patients on therapy.
Original language | English |
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Journal | MYCOSES |
Early online date | 25 Jan 2020 |
DOIs | |
Publication status | Published - 20 Mar 2020 |
Keywords
- Aspergillus fumigatus
- azoles
- antifungal resistance
- polymerase chain reaction
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MFIG: Manchester Fungal Infection Group (MFIG)
Bromley, M. (PI), Bertuzzi, M. (PI), Gago, S. (PI), Denning, D. (PI), Kosmidis, C. (PI), Bowyer, P. (PI), Amich Elias, J. (PI), Richardson, M. (PI), Richardson, R. (PI), Van Rhijn, N. (PI) & Bottery, M. (PI)
15/08/13 → …
Project: Research