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.
Alexander F A D SchauwvliegheNick de JongeKarin van DijkPaul E VerweijRoger J BrüggemannBart J BiemondAldert BartPeter A von dem BorneAnnelies VerbonMartha T van der BeekAstrid M P DemandtGuy J OudhuisJan J CornelissenWalter J F M van der VeldenLambert F R SpanGreetje A KampingaAnke H BrunsAlieke G VonkPieter-Jan A HaasJeanette K DoorduijnBart J A RijndersPublished in: Mycoses (2018)
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.
Keyphrases
- candida albicans
- end stage renal disease
- newly diagnosed
- ejection fraction
- chronic kidney disease
- peritoneal dialysis
- study protocol
- clinical trial
- healthcare
- prognostic factors
- radiation therapy
- bone marrow
- patient reported outcomes
- intensive care unit
- cross sectional
- dendritic cells
- drug induced
- respiratory failure
- rectal cancer
- combination therapy
- quantum dots
- pseudomonas aeruginosa
- locally advanced
- aortic dissection
- smoking cessation