Verweij Paul E, van de Sande-Bruisma Nienke, Kema Gert H J, Melchers Willem J G
Universitair Medisch Centrum St Radboud, afd. Medische Microbiologie, Nijmegen, the Netherlands.
Ned Tijdschr Geneeskd. 2012;156(25):A4458.
The mould Aspergillus fumigatus may develop mechanisms that confer resistance to itraconazole, voriconazole and posaconazole. In the Netherlands a dominant resistance mechanism referred to as TR/L98H is found. In A. fumigatus isolates recovered from clinical samples in Dutch hospitals the prevalence of azole resistance varied between 0.8% and 9.4%. The TR/L98H resistance mechanism probably develops in our environment, as azoles are frequently used for crop protection and material preservation. It is likely that breathing in the resistant spores of these strains from the environment leads to clinical infection. More research is needed to understand the environmental route of resistance development and to enable effective measures to prevent this occurring. Azole resistance is associated with treatment failure. Of 8 patients with azole-resistant invasive aspergillosis 7 died within 12 weeks of diagnosis. Alternative treatment regimens might include lipid-formulation of amphotericin B or a combination of voriconazole and an echinocandin, but there is little data available to support these choices. Physicians who treat patients with Aspergillus diseases should be aware of the possibility of azole resistance, also in azole-naïve patients.
烟曲霉可能会形成对伊曲康唑、伏立康唑和泊沙康唑产生耐药性的机制。在荷兰发现了一种主要的耐药机制，称为TR/L98H。在从荷兰医院临床样本中分离出的烟曲霉中，唑类耐药的发生率在0.8%至9.4%之间。TR/L98H耐药机制可能在我们的环境中产生，因为唑类经常用于作物保护和材料保存。从环境中吸入这些菌株的耐药孢子很可能会导致临床感染。需要更多的研究来了解耐药性产生的环境途径，并采取有效的预防措施。唑类耐药与治疗失败有关。在8例唑类耐药的侵袭性曲霉病患者中，7例在诊断后12周内死亡。替代治疗方案可能包括两性霉素B的脂质制剂或伏立康唑与棘白菌素的联合使用，但几乎没有数据支持这些选择。治疗曲霉病患者的医生应该意识到唑类耐药的可能性，即使是未使用过唑类药物的患者。
