TY - JOUR
T1 - The diagnosis and treatment of invasive aspergillosis in Dutch haematology units facing a rapidly increasing prevalence of azole-resistance
T2 - A nationwide survey and rationale for the DB‐MSG 002 study protocol
AU - Schauwvlieghe, Alexander F. A. D.
AU - de Jonge, Nick
AU - van Dijk, Karin
AU - Verweij, Paul E.
AU - Bruggemann, Roger J.
AU - Biemond, Bart J.
AU - Bart, Aldert
AU - von dem Borne, Peter A.
AU - Verbon, Annelies
AU - van der Beek, Martha T.
AU - Demandt, Astrid M. P.
AU - Oudhuis, Guy J.
AU - Cornelissen, Jan J.
AU - van der Velden, Walter J. F. M.
AU - Span, Lambert F. R.
AU - Kampinga, Greetje A.
AU - Bruns, Anke H.
AU - Vonk, Alieke G.
AU - Haas, Pieter-Jan A.
AU - Doorduijn, Jeanette K.
AU - Rijnders, Bart J. A.
PY - 2018/9/1
Y1 - 2018/9/1
N2 - 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.
AB - 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.
KW - azole-resistance
KW - IFD
KW - invasive aspergillosis
KW - management
KW - BRONCHOALVEOLAR LAVAGE FLUID
KW - LIPOSOMAL AMPHOTERICIN-B
KW - PLACEBO-CONTROLLED TRIAL
KW - ACUTE MYELOID-LEUKEMIA
KW - FUNGAL-INFECTIONS
KW - FLUCONAZOLE PROPHYLAXIS
KW - MOLD INFECTIONS
KW - FUMIGATUS
KW - POSACONAZOLE
KW - DISEASE
U2 - 10.1111/myc.12788
DO - 10.1111/myc.12788
M3 - Article
C2 - 29687483
VL - 61
SP - 656
EP - 664
JO - Mycoses
JF - Mycoses
SN - 0933-7407
IS - 9
ER -