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ESCMID-EFISG Survey on Diagnostic and Therapeutic Capacity for Invasive Fungal Infections in Belgium, the
Robina Aerts1,2, Lize Cuypers3,4, Eelco F J Meijer5,6
1Department of Haematology, Leuven University Hospitals, Leuven, Belgium.
Introduction:
Invasive fungal infections (IFI) are a major clinical challenge, particularly in immunocompromised patients, and are associated with high morbidity and mortality. With the increasing prevalence of immunosuppressive conditions and ageing populations, the incidence of IFI is rising globally.
Objective:
This survey aims to evaluate the diagnostic and therapeutic capacities for IFI in Belgium, the Netherlands, and Luxembourg (Benelux), a region of high azole-resistance among Aspergillus fumigatus isolates.
Methods:
A survey evaluating the diagnostic and therapeutic capacity for IFI was conducted in the Benelux. Data were collected from specialists via an online case report form between March and September 2023. The survey addressed patient characteristics, access to microbiology labs, diagnostic methods (microscopy, culture, molecular diagnostics, etc.), IFI incidence, and the availability of antifungal drugs and therapeutic drug monitoring.
Results:
In total, 32 hospitals responded to the questionnaire (12 [38%] from the Netherlands, 19 [59%] from Belgium and one [3%] from Luxembourg). Antifungal susceptibility tests were available in 29 institutions (91%), constituting 84% of the centres in Belgium and 100% for the Netherlands (p = 0.265). Aspergillus PCR testing was available in 12 centres in Belgium (63%) while in 11 centres in the Netherlands (92%, p = 0.108). Mucorales PCR testing was available in 56% of centres. Treatment with at least one amphotericin B formulation was only available in 84% of the responding centres. Therapeutic drug monitoring (TDM), although recommended, was possible for voriconazole in 26 centres (81%) while for posaconazole in 24 centres (75%). Significantly more testing (diagnostic tests and TDM) was outsourced in Belgium compared to the Netherlands (p < 0.001).
Conclusions:
Antifungal susceptibility testing is widely available in Belgium and the Netherlands, but implementation in areas with high azole resistance for Aspergillus fumigatus is not yet universal, and techniques vary. Tests for coinfections, like Mucorales PCR, were only available in half of the centres. More testing is outsourced in Belgium, likely due to differences in reference centre organisation, country size, transport, and reimbursement. Delays in diagnosis can impact patient outcomes, so awareness of test availability and transport times is crucial.
Insights
Invasive fungal infection diagnostics vary across Benelux hospitals, with antifungal susceptibility testing widely available but molecular tests for coinfections less common. Delays in diagnosis due to testing availability and transport times are a concern.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Clinical Diagnostics
Background:
- Invasive fungal infections (IFI) pose significant morbidity and mortality risks, especially in immunocompromised individuals.
- Rising incidence of IFI globally due to aging populations and increased immunosuppression.
- High azole resistance in Aspergillus fumigatus isolates in the Benelux region necessitates robust diagnostic and therapeutic strategies.
Purpose of the Study:
- To assess the diagnostic and therapeutic capabilities for IFI within Belgium, the Netherlands, and Luxembourg (Benelux).
- To identify regional variations in the availability of diagnostic tests and antifungal treatments.
- To evaluate the impact of azole resistance on IFI management in the Benelux.
Main Methods:
- A survey was conducted among hospitals in the Benelux region from March to September 2023.
- Data collected via an online case report form from specialists on patient characteristics, lab access, diagnostic methods, IFI incidence, and antifungal drug availability.
- Included assessment of microscopy, culture, molecular diagnostics, antifungal susceptibility testing, and therapeutic drug monitoring (TDM).
Main Results:
- Antifungal susceptibility testing is available in 91% of surveyed institutions (100% in the Netherlands, 84% in Belgium).
- Aspergillus PCR testing availability was higher in the Netherlands (92%) compared to Belgium (63%); Mucorales PCR was available in 56% of centers.
- Therapeutic drug monitoring for voriconazole and posaconazole was available in 81% and 75% of centers, respectively. More testing was outsourced in Belgium.
Conclusions:
- While antifungal susceptibility testing is common, its universal implementation and standardization for azole-resistant Aspergillus fumigatus require improvement.
- Availability of molecular tests for coinfections like Mucorales PCR is limited, impacting comprehensive diagnosis.
- Differences in testing outsourcing between Belgium and the Netherlands highlight the need for optimized logistics, considering transport times and reimbursement to prevent diagnostic delays and improve patient outcomes.
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