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Amphotericin B in vitro resistance is associated with fatal Aspergillus flavus infection

Inès Hadrich1, Fattouma Makni, Sourour Neji

  • 1Laboratoire de Biologie Moléculaire Parasitaire et Fongique, Faculté de Médecine, Sfax, Tunisia.

Medical Mycology
|May 17, 2012
PubMed

Insights

Invasive aspergillosis patients infected with amphotericin B-resistant Aspergillus flavus showed poorer outcomes. Antifungal susceptibility testing is crucial for guiding invasive aspergillosis treatment decisions.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Clinical Microbiology

Background:

  • The correlation between in vitro antifungal susceptibility and patient outcomes in invasive aspergillosis (IA) is not fully established.
  • Aspergillus flavus is a significant cause of IA, particularly in immunocompromised patients.

Purpose of the Study:

  • To investigate the association between in vitro antifungal susceptibility of Aspergillus flavus and patient outcomes in invasive aspergillosis.
  • To determine if amphotericin B resistance in A. flavus predicts treatment failure or mortality.

Main Methods:

  • Determined in vitro susceptibility of 37 A. flavus isolates from 14 patients with hematological malignancies to amphotericin B using Etest.
  • Classified isolates as susceptible (MIC < 2 mg/l) or resistant (MIC ≥ 2 mg/l).
  • Analyzed patient survival rates in relation to A. flavus susceptibility, primary disease, and antifungal treatment using logistic regression.

Main Results:

  • A high prevalence of amphotericin B resistance (84%) was observed in the A. flavus isolates.
  • Patients infected with amphotericin B-resistant A. flavus had significantly lower survival rates (22%) compared to those with susceptible isolates (67%) when treated with amphotericin B.
  • Infection with amphotericin B-resistant A. flavus and acute myelocytic leukemia were independent predictors of death.

Conclusions:

  • In vitro resistance of Aspergillus flavus to amphotericin B is a significant predictor of poor outcomes in patients with invasive aspergillosis treated with this agent.
  • Antifungal susceptibility testing remains critical for selecting appropriate therapy and improving patient outcomes in invasive aspergillosis.
  • Despite advances in non-culture-based methods, in vitro susceptibility data are essential for clinical decision-making.

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