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

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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(®)). 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.

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          Author and article information

          Journal
          Drug Resist. Updat.
          Drug resistance updates : reviews and commentaries in antimicrobial and anticancer chemotherapy
          1532-2084
          1368-7646
          : 21-22
          Affiliations
          [1 ] Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands. Electronic address: Paul.Verweij@radboudumc.nl.
          [2 ] General Medicine and Infectious Diseases Units, Alfred Health, Melbourne, Australia.
          [3 ] University of Wisconsin School of Medicine and Public Health, Madison, USA.
          [4 ] Unit of Mycology and Parasitology, Statens Serum Institut, Copenhagen, Denmark.
          [5 ] Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands.
          [6 ] Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
          [7 ] 1st Department of Internal Medicine, Clinical Trials Centre Cologne - BMBF 01KN1106, Centre for Integrated Oncology CIO Köln Bonn, and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Cologne, Germany.
          [8 ] National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
          [9 ] Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Paediatric Haematology/Oncology, University Children's Hospital, Muenster, Germany.
          [10 ] Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
          [11 ] Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
          [12 ] Department of Microbiology and Immunology and National Reference Center for Mycosis, Universitaire Ziekenhuizen Campus Gasthuisberg, KU Leuven, Leuven, Belgium.
          [13 ] Department of Haematology, Universitaire Ziekenhuizen Campus Gasthuisberg, KU Leuven, Leuven, Belgium.
          [14 ] Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
          [15 ] Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
          [16 ] Departments of Medicine, and Microbiology and Immunology, McGill University, Montreal, Canada.
          [17 ] Division of Infectious Diseases, University of Genova (DISSAL), A.O.U. IRCCS San Martino-IST, Genoa, Italy.
          [18 ] Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom.
          [19 ] Department of Haematology, Radboud University Medical Centre, Nijmegen, The Netherlands.
          Article
          S1368-7646(15)00035-7
          10.1016/j.drup.2015.08.001
          26282594
          73a62826-f61e-401f-bcf7-7febb5a21e0b
          Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
          History

          Aspergillus fumigatus,Azole resistance,Chronic aspergillosis,Invasive aspergillosis,Voriconazole

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