ESCMID-EFISG Survey on Diagnostic and Therapeutic Capacity for Invasive Fungal Infections in Belgium, the Netherlands, and Luxembourg: A Focus on High Azole Resistance.
Aerts, Robina; Cuypers, Lize; Meijer, Eelco F Jet al.
[en] [en] INTRODUCTION: Invasive fungal infections (IFI) are a major clinical challenge, particularly in immunocompromised patients, and are associated with high morbidity and mortality. With the increasing prevalence of immunosuppressive conditions and ageing populations, the incidence of IFI is rising globally.
OBJECTIVE: This survey aims to evaluate the diagnostic and therapeutic capacities for IFI in Belgium, the Netherlands, and Luxembourg (Benelux), a region of high azole-resistance among Aspergillus fumigatus isolates.
METHODS: A survey evaluating the diagnostic and therapeutic capacity for IFI was conducted in the Benelux. Data were collected from specialists via an online case report form between March and September 2023. The survey addressed patient characteristics, access to microbiology labs, diagnostic methods (microscopy, culture, molecular diagnostics, etc.), IFI incidence, and the availability of antifungal drugs and therapeutic drug monitoring.
RESULTS: In total, 32 hospitals responded to the questionnaire (12 [38%] from the Netherlands, 19 [59%] from Belgium and one [3%] from Luxembourg). Antifungal susceptibility tests were available in 29 institutions (91%), constituting 84% of the centres in Belgium and 100% for the Netherlands (p = 0.265). Aspergillus PCR testing was available in 12 centres in Belgium (63%) while in 11 centres in the Netherlands (92%, p = 0.108). Mucorales PCR testing was available in 56% of centres. Treatment with at least one amphotericin B formulation was only available in 84% of the responding centres. Therapeutic drug monitoring (TDM), although recommended, was possible for voriconazole in 26 centres (81%) while for posaconazole in 24 centres (75%). Significantly more testing (diagnostic tests and TDM) was outsourced in Belgium compared to the Netherlands (p < 0.001).
CONCLUSIONS: Antifungal susceptibility testing is widely available in Belgium and the Netherlands, but implementation in areas with high azole resistance for Aspergillus fumigatus is not yet universal, and techniques vary. Tests for coinfections, like Mucorales PCR, were only available in half of the centres. More testing is outsourced in Belgium, likely due to differences in reference centre organisation, country size, transport, and reimbursement. Delays in diagnosis can impact patient outcomes, so awareness of test availability and transport times is crucial.
Disciplines :
Laboratory medicine & medical technology
Author, co-author :
Aerts, Robina ; Department of Haematology, Leuven University Hospitals, Leuven, Belgium ; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
Cuypers, Lize; KU Leuven, Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, Leuven, Belgium ; Department of Laboratory Medicine, National Reference Centre for Rotavirus, University Hospitals of Leuven, Leuven, Belgium
Meijer, Eelco F J; Department of Medical Microbiology and Immunology, Canisius-Wilhelmina Hospital (CWZ)/Dicoon, Nijmegen, the Netherlands ; Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands
Kohnen, Michel; National Service of Infectious Diseases, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
Meis, Jacques F ; Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands ; Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
Cornely, Oliver A ; Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany ; Department I of Internal Medicine, European Confederation for Medical Mycology (ECMM) Excellence Center, University of Cologne, Cologne, Germany ; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany ; Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
Lagrou, Katrien; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium ; Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium ; National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
Salmanton-García, Jon ; Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany ; Department I of Internal Medicine, European Confederation for Medical Mycology (ECMM) Excellence Center, University of Cologne, Cologne, Germany
Layios, Nathalie ; Université de Liège - ULiège > Département des sciences cliniques
Language :
English
Title :
ESCMID-EFISG Survey on Diagnostic and Therapeutic Capacity for Invasive Fungal Infections in Belgium, the Netherlands, and Luxembourg: A Focus on High Azole Resistance.
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