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SDG 3: Antimicrobial resistance

Abstract

Background

Dutch 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.

Aim

Our objective was to evaluate changes in antifungal susceptibility among species isolates from patients with invasive aspergillosis.

Methods

Laboratories 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.

Results

Overall, 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.

Conclusions

Geographical 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.

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2025-05-08
2025-05-15
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Doubling of triazole resistance rates in invasive aspergillosis over a 10-year period, Belgium, 1 April 2022 to 31 March 2023
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Lize+Cuypers&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cuypers Lize</a>, <a href="/search?value1=Robina+Aerts&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Aerts Robina</a>, <a href="/search?value1=Otto+Van+de+gaer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Van de gaer Otto</a>, <a href="/search?value1=Lore+Vinken&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vinken Lore</a>, <a href="/search?value1=Rita+Merckx&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Merckx Rita</a>, <a href="/search?value1=Veerle+Gerils&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gerils Veerle</a>, <a href="/search?value1=Greetje+Vande+Velde&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vande Velde Greetje</a>, <a href="/search?value1=Agustin+Res%C3%A9ndiz-Sharpe&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Reséndiz-Sharpe Agustin</a>, <a href="/search?value1=Johan+Maertens&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Maertens Johan</a>, <a href="/search?value1=Katrien+Lagrou&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lagrou Katrien</a></span>. Doubling of triazole resistance rates in invasive aspergillosis over a 10-year period, Belgium, 1 April 2022 to 31 March 2023. <a href="/content/ecdc">Euro Surveill.</a> 2025;30(18):pii=2400559. <a href="https://doi.org/10.2807/1560-7917.ES.2025.30.18.2400559" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2025.30.18.2400559</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 23 Aug 2024;&nbsp;&nbsp; <span class="generated">Accepted</span>: 11 Dec 2024 </span> </p>
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