Cuypers Lize, Aerts Robina, Van de Gaer Otto, Vinken Lore, Merckx Rita, Gerils Veerle, Vande Velde Greetje, Reséndiz-Sharpe Agustin, Maertens Johan, Lagrou Katrien
Department of Laboratory Medicine, National Reference Centre for Mycosis, University Hospitals Leuven, Leuven, Belgium.
Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, KU Leuven, Leuven, Belgium.
Euro Surveill. 2025 May;30(18). doi: 10.2807/1560-7917.ES.2025.30.18.2400559.
BackgroundDutch national treatment guidelines for fungal infections have been adapted based on surveillance findings of triazole resistance rates >10% in species isolates. In Belgium, nationwide resistance data have not been collected since 2011.AimOur objective was to evaluate changes in antifungal susceptibility among species isolates from patients with invasive aspergillosis.MethodsLaboratories across Belgium were invited to send all clinically relevant species isolates from patients diagnosed with invasive aspergillosis, collected between April 2022 and March 2023, to the National Reference Centre for Mycosis at UZ Leuven for identification and antifungal susceptibility testing.ResultsOverall, 29 clinical laboratories contributed 309 isolates from 297 patients. Median patient age was 66 years (range: 6 months-96 years). Among isolates, 61% (189/309) were from male patients. At species level, isolates predominated (278/309, 90%), with a 9.7% (27/278) triazole resistance rate, compared to the 4.6% rate found in 2011. Of 27 resistant isolates, successful sequencing of 26 showed 20 with the TR/L98H resistance mechanism. Across the country, local triazole resistance rates varied. Among provinces in the Flanders region, Antwerp had the highest resistance rate (15.4%: 10/65; p = 0.082), Flemish Brabant (6/48) also had a rate >10%, while Limburg (2/46) had the lowest rate.ConclusionsGeographical differences in triazole resistance rates stress the importance of implementing broad prospective surveillance initiatives, not limited to one region or one hospital. In Belgium, triazole resistance rates have doubled over 10 years, nearly attaining the 10% threshold, warranting re-evaluation of local empirical antifungal treatment regimen decisions.
背景
荷兰针对真菌感染的国家治疗指南已根据曲霉菌种分离株中三唑耐药率>10%的监测结果进行了调整。在比利时，自2011年以来尚未收集全国范围的耐药数据。
目的
我们的目标是评估侵袭性曲霉病患者的曲霉菌种分离株的抗真菌药敏变化。
方法
邀请比利时各地的实验室将2022年4月至2023年3月期间收集的所有来自诊断为侵袭性曲霉病患者的临床相关曲霉菌种分离株，送至鲁汶大学医院的国家真菌病参考中心进行鉴定和抗真菌药敏试验。
结果
总体而言，29个临床实验室提供了来自297例患者的309株分离株。患者年龄中位数为66岁（范围：6个月至96岁）。在分离株中，61%（189/309）来自男性患者。在菌种水平上，曲霉菌株占主导（278/309，90%），三唑耐药率为9.7%（27/278），而2011年发现的耐药率为4.6%。在27株耐药分离株中，26株成功测序显示20株具有TR/L98H耐药机制。在全国范围内，当地曲霉菌的三唑耐药率各不相同。在弗拉芒地区的省份中，安特卫普的耐药率最高（15.4%：10/65；p = 0.082），弗拉芒布拉班特（6/48）的耐药率也>10%，而林堡（2/46）的耐药率最低。
结论
曲霉菌三唑耐药率的地理差异凸显了实施广泛前瞻性监测举措的重要性，而不仅限于一个地区或一家医院。在比利时，三唑耐药率在10年内翻了一番，几乎达到10%的阈值，有必要重新评估当地经验性抗真菌治疗方案的决策。
