Montesinos I, Argudín M A, Hites M, Ahajjam F, Dodémont M, Dagyaran C, Bakkali M, Etienne I, Jacobs F, Knoop C, Patteet S, Lagrou K
Department of Microbiology, CUB-Erasme, Université Libre de Bruxelles, Brussels, Belgium
Department of Microbiology, CUB-Erasme, Université Libre de Bruxelles, Brussels, Belgium.
J Clin Microbiol. 2017 Aug;55(8):2391-2399. doi: 10.1128/JCM.00520-17. Epub 2017 May 17.
Azole-resistant is an increasing worldwide problem with major clinical implications. Surveillance is warranted to guide clinicians to provide optimal treatment to patients. To investigate azole resistance in clinical isolates in our institution, a Belgian university hospital, we conducted a laboratory-based surveillance between June 2015 and October 2016. Two different approaches were used: a prospective culture-based surveillance using VIPcheck on unselected ( = 109 patients, including 19 patients with proven or probable invasive aspergillosis [IA]), followed by molecular detection of mutations conferring azole resistance, and a retrospective detection of azole-resistant in bronchoalveolar lavage fluid using the commercially available AsperGenius PCR ( = 100 patients, including 29 patients with proven or probable IA). By VIPcheck, 25 azole-resistant specimens were isolated from 14 patients (12.8%). Of these 14 patients, only 2 had proven or probable IA (10.5%). Mutations at the gene were observed in 23 of the 25 isolates; TR/L98H was the most prevalent mutation (46.7%), followed by TR/Y121F/T289A (26.7%). Twenty-seven (27%) patients were positive for the presence of species by AsperGenius PCR. was detected by AsperGenius in 20 patients, and 3 of these patients carried mutations. Two patients had proven or probable IA and mutation (11.7%). Our study has shown that the detection of azole-resistant in clinical isolates was a frequent finding in our institution. Hence, a rapid method for resistance detection may be useful to improve patient management. Centers that care for immunocompromised patients should perform routine surveillance to determine their local epidemiology.
唑类耐药是一个日益严重的全球性问题，具有重大临床意义。有必要进行监测，以指导临床医生为患者提供最佳治疗。为了调查我们所在机构（一家比利时大学医院）临床分离株中的唑类耐药情况，我们在2015年6月至2016年10月期间开展了一项基于实验室的监测。采用了两种不同方法：一种是对未筛选的患者（n = 109例，包括19例确诊或疑似侵袭性曲霉病[IA]的患者）使用VIPcheck进行基于培养的前瞻性监测，随后对赋予唑类耐药性的突变进行分子检测；另一种是使用市售的AsperGenius PCR对支气管肺泡灌洗液中的唑类耐药菌进行回顾性检测（n = 100例，包括29例确诊或疑似IA的患者）。通过VIPcheck，从14例患者（12.8%）中分离出25份唑类耐药菌标本。在这14例患者中，只有2例确诊或疑似IA（10.5%）。在25株分离菌中的23株中观察到了基因的突变；TR/L98H是最常见的突变（46.7%），其次是TR/Y121F/T289A（26.7%）。通过AsperGenius PCR检测，27%（27例）患者的曲霉菌种呈阳性。AsperGenius在20例患者中检测到了曲霉，其中3例患者携带曲霉突变。2例确诊或疑似IA的患者携带曲霉突变（11.7%）。我们的研究表明，在我们机构中临床分离株中检测到唑类耐药菌是一个常见现象。因此，一种快速的耐药检测方法可能有助于改善患者管理。照顾免疫受损患者的中心应进行常规监测，以确定当地的流行病学情况。
