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The diagnosis and treatment of invasive aspergillosis in Dutch haematology units facing a rapidly increasing prevalence of azole-resistance. A nationwide survey and rationale for the DB-MSG 002 study protocol.

Schauwvlieghe, Alexander F A D; de Jonge, Nick; van Dijk, Karin; Verweij, Paul E; Brüggemann, Roger J; Biemond, Bart J; Bart, Aldert; von dem Borne, Peter A; Verbon, Annelies; van der Beek, Martha T; Demandt, Astrid M P; Oudhuis, Guy J; Cornelissen, Jan J; van der Velden, Walter J F M; Span, Lambert F R; Kampinga, Greetje A; Bruns, Anke H; Vonk, Alieke G; Haas, Pieter-Jan A; Doorduijn, Jeanette K; Rijnders, Bart J A.
Mycoses; 2018 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-29687483
Patients with haematological malignancies are at risk for invasive fungal diseases (IFD). A survey was conducted in all Dutch academic haematology centres on their current diagnostic, prophylactic and therapeutic approach towards IFD in the context of azole-resistance. In all 8 centres, a haematologist and microbiologist filled in the questionnaire that focused on different subgroups of haematology patients. Fungal prophylaxis during neutropaenia was directed against Candida and consisted of fluconazole and/or amphotericin B suspension. Mould-active prophylaxis was given to acute myeloid leukaemia patients during chemotherapy in 2 of 8 centres. All centres used azole prophylaxis in a subset of patients with graft-versus-host disease. A uniform approach towards the diagnosis and treatment of IFD and in particular azole-resistant Aspergillus fumigatus was lacking. In 2017, all centres agreed to implement a uniform diagnostic and treatment algorithm regarding invasive aspergillosis with a central role for comprehensive diagnostics and PCR-based detection of azole-resistance. This study (DB-MSG 002) will re-evaluate this algorithm when 280 patients have been treated. A heterogeneous approach towards antifungal prophylaxis, diagnosis and treatment was apparent in the Netherlands. Facing triazole-resistance, consensus was reached on the implementation of a uniform diagnostic approach in all 8 centres.
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