Eurosurveillance - Volume 30, Issue 18, 08 May 2025

Dutch national treatment guidelines for fungal infections have been adapted based on surveillance findings of triazole resistance rates >10% in Aspergillus species isolates. In Belgium, nationwide resistance data have not been collected since 2011.

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

Laboratories across Belgium were invited to send all clinically relevant Aspergillus 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.

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, Aspergillus fumigatus 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 Cyp51A sequencing of 26 showed 20 with the TR34/L98H resistance mechanism. Across the country, local A. fumigatus 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.

Geographical differences in A. fumigatus 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.

HIV testing based on indicator conditions is recommended to diagnose HIV earlier.

Our aim was to assess opportunities for earlier diagnosis of HIV.

This is a retrospective study on people living with HIV (PLWH) included in the national HIV register. We collected data on public primary outpatient healthcare (PHC) (2011–2019), secondary and tertiary outpatient healthcare (STHC), and all inpatient care (1996–2019) from the Care Register for Health Care from the presumed acquisition, estimated by CD4⁺ T-cell count at diagnosis, until the diagnosis of HIV.

Of 907 PLWH diagnosed between 2011 and 2019, 522 (58%) had ≥ 1 healthcare contact at any level between HIV acquisition and > 30 days before diagnosis. At least one European Centre for Disease Prevention and Control (ECDC) indicator condition was recorded for 119 (23% of 522), and 112 (21%) were born in a high-prevalence country. In total, 384 of 907 (42%) had visited a PHC physician, and 58% of those with CD4⁺ T-cell count < 200 cells/μL at diagnosis. Of 2,082 PLWH diagnosed between 1996 and 2019, 869 (42%) had STHC outpatient contacts > 30 days before diagnosis, 18% with ≥ 1 ECDC indicator condition, and 367 (18%) had been hospitalised, 20% with ≥ 1 ECDC indicator condition. The most common ECDC indicator conditions > 30 days before diagnosis at all levels of healthcare were pneumonia, sexually transmitted infections, unexplained fever, herpes zoster, pregnancy and lymphadenopathy.

We recommend enhancing indicator condition-based HIV testing by all healthcare providers, particularly for gonorrhoea, syphilis and, for persons younger than 50 years, also herpes zoster and lymphadenopathy.

Accurate burden estimates are necessary to inform priority setting and rational resource allocation. Weighting prevalence inversely proportional to time-at-risk has been proposed as a solution for length-biased sampling, an important limitation affecting prevalence to incidence conversion for healthcare-associated infections (HAIs).

This study aimed to update Italian burden estimates by calculating HAI incidence, attributable mortality and disability-adjusted life years (DALYs). Further, we describe an adapted methodology for burden estimations.

We used data from the latest European Centre for Disease Prevention and Control (ECDC) point prevalence survey (PPS) of HAIs, conducted in Italy in November 2022, to calculate the burden of five major HAIs at national level. We adapted the Burden of Communicable Diseases in Europe (BCoDE) methodology to include inverse probability weighting and compared results of naïve and weighted calculations.

The national sample included 18,397 patients. Overall, 564.8 DALYs per 100,000 general population resulted from weighted calculations (95% uncertainty interval (UI): 450.04–694.38), with an annual incidence of 685.42 cases per 100,000 general population (95% UI: 611.09–760.86) and 33.23 deaths per 100,000 general population per year (95% UI: 28.62–38.33). Concerning naïve estimates, overall 1,017.81 DALYs per 100,000 general population were calculated (95% UI: 855.16–1,190.59). In both calculations, healthcare-acquired bloodstream infections had the highest burden in terms of DALYs per 100,000 hospitalised and general population.

Our study confirmed the substantial burden of HAIs in Italy and renews the need to prioritise resources for infection prevention and control interventions.