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

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Abstract

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.

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Acknowledgements

We are indebted to physicians, nurses, data managers, clinical microbiologists, radiologists, pathologists and laboratory technicians at the participating centres.

Conflicts of interest

K. L. M. has received travel grants from Pfizer, Schering-Plough (now MSD) and MSD. S.J.H. has received support grants from Gilead, Pfizer and the Fungal Research Trust, travel grants from Astellas and Schering-Plough, and has been paid for talks on behalf of Pfizer and Astellas. J.D.K. has received travel grants, and has been paid to give talks at various meetings sponsored by Pfizer, Merck, and Gilead. M.C.A. has been paid for talks on behalf of Astellas, Merck, Pfizer, Schering-Plough, Spepharm, Gilead and Swedish Orphan, acted as consultant for Merck, Astellas, Spepharm and Pfizer, received research grants from Astellas, Pfizer, Roche, Schering-Plough and Merck and received travel grants from Astellas, Merck, Pfizer, Schering-Plough and Swedish Orphan. H.K.J., K.F., B.G.-H., and R.H.J. have no conflicts to report.

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Authors and Affiliations

  1. Mycology Unit, Department of Microbiological Surveillance and Research, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark

    K. L. Mortensen, R. H. Jensen & M. C. Arendrup

  2. Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

    H. K. Johansen

  3. Department of Clinical Microbiology, Aarhus University Hospital Skejby, Aarhus, Denmark

    K. Fuursted

  4. Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark

    J. D. Knudsen

  5. Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark

    B. Gahrn-Hansen

  6. School of Translational Medicine, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK

    S. J. Howard

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  1. K. L. Mortensen
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Correspondence to K. L. Mortensen.

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Mortensen, K.L., Johansen, H.K., Fuursted, K. et al. A prospective survey of Aspergillus spp. in respiratory tract samples: prevalence, clinical impact and antifungal susceptibility. Eur J Clin Microbiol Infect Dis 30, 1355–1363 (2011). https://doi.org/10.1007/s10096-011-1229-7

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