Core Recomendations
In this article, the authors review the literature on Antimicrobial Stewardship (AMS) best practices and discuss Antifungal Stewardship (AFS) through the lens of the global core elements of AMS. We offer recommendations for best practices in AFS based on a synthesis of this evidence by an interdisciplinary expert panel of members of the Mycoses Study Group Education and Research Consortium. We also discuss research directions in this rapidly evolving field. AFS is an emerging and important component of AMS, yet requires special considerations in certain areas such as expertise, education, interventions to optimize utilization, therapeutic drug monitoring, and data analysis and reporting.
Research articles
Spectrum of pulmonary fungal pathogens, associated risk factors, and anti-fungal susceptibility pattern among persons with presumptive tuberculosis at Gombe, Nigeria. Sani et. al., 2020.
This study was aimed to isolate, phenotypically identify, determine the prevalence of pulmonary fungal pathogens and antifungal susceptibility pattern of isolates of presumptive tuberculosis (PTB) patients attending Federal Teaching Hospital (FTH) Gombe, Nigeria. There were 216 participants who donated sputum and the authors found that 74% of them had pulmonary fungal pathogens, detected using standard microscopy & staining. The majority were resistant to fluconazole. Major risk factors (obtained via the use of structured questionnaires) were cigarette smoking, prolonged antibiotic use, and possession of a domestic cat.
Benefits of a Pediatric Antimicrobial Stewardship Program in Antimicrobial Use and Quality of Prescriptions in a Referral Children's Hospital.Velasco Arnaiz E. et. al, 2020.
The authors evaluated the results of the first 24 months of a post prescription review with feedback (PPRF)-based antimicrobial stewardship program (ASP) in a European referral children´s hospital.
Total antimicrobial use and antibacterial use significantly decreased during the intervention period (p=0.002 and p=0.001 respectively), and total antifungal use remained stable. A significant decline in parenteral antimicrobial use was also observed (P < .001). Expenditure fell, and a trend towards improvement in quality of prescriptions was also observed.
Recently, a pan-azole-resistant clinical Aspergillus fumigatus isolate was identified to carry the mutation P88L in subunit HapE of the CCAAT-binding complex (CBC), a conserved eukaryotic transcription factor. Here, the authors define the mechanistic basis for resistance in this isolate by showing that the HapEP88L mutation interferes with the CBC's ability to bend and sense CCAAT motifs. This failure leads to transcriptional derepression of the cyp51A gene, which encodes the target of azoles, the 14-α sterol demethylase Cyp51A, and ultimately causes drug resistance. In addition, they demonstrate that the CBC-associated transcriptional regulator HapX assists cyp51A repression in low-iron environments and that this iron-dependent effect is lost in the HapEP88L mutant. Altogether, these results indicate that the mutation HapEP88L confers increased resistance to azoles compared with wt A. fumigatus, particularly in low-iron clinical niches such as the lung.
Veterinary article
Low rate of azole resistance in cases of avian aspergillosis in Germany. Amelia E. Barber, 2020.
Aspergillosis is the most common fungal disease of the avian respiratory tract. Due to delayed diagnosis and treatment failure, the outcome of these infections is often poor. The authors investigate 159 cases of avian aspergillosis among captive birds in Germany to define clinical features as well as the frequency of in vitro triazole resistance. Adult birds were more likely to present with clinical signs compared to juvenile birds, and dyspnoea was the most common clinical sign, present in 53% of birds. Molecular species identification indicated that all infections were caused by Aspergillus fumigatus. Only one of 159 independent isolates was azole resistant.
Reviews
Classification of Aspergillus, Penicillium, Talaromyces and related genera (Eurotiales): An overview of families, genera, subgenera, sections, series and species. Houbraken et. al., 2020.
The classification of the Eurotiales at family and genus level is traditionally based on phenotypic characters, and this classification has since been challenged using sequence-based approaches. Here, the authors re-evaluated the relationships between families and genera of the Eurotiales using a nine-gene sequence dataset. Based on this analysis, the new family Penicillaginaceae is introduced and four known families are accepted: Aspergillaceae, Elaphomycetaceae, Thermoascaceae and Trichocomaceae.
Aspergillus is subdivided into six subgenera, 27 sections (five new) and 75 series (73 new, one new combination), and Penicillium in two subgenera, 32 sections (seven new) and 89 series (57 new, six new combinations).
Up to 2014, 339 Aspergillus, 354 Penicillium and 88 Talaromyces species were accepted. These numbers increased significantly, and the current list includes 446 Aspergillus (32% increase)......
Anti-fungal immunity is characterized by the continuous interplay between immune activation and immune regulation processes. These processes have now been clearly shown not only in animal pre-clinical models but also in humans. To create and maintain this immune homeostasis, reciprocal interactions among the host immune system, fungal pathogens, and the microbiome are crucial. Notably, the microbiome exerts multiple direct and indirect antifungal effects that are particularly aimed at minimizing host tissue damage. Thus, in this microbiome era, the architecture of 3D culture system or 'tissue organoids' might finally represent a simple but effective in vitro 'holobiont' to unravel the diverse interactions and adaptations that evolve to overcome fungal infections.
Patients and carers
Maybe you or a loved one has just received a diagnosis of aspergillosis and you’re not sure where to start. Or maybe you need to share information about your condition with your doctor, carer, housing association or benefits assessor. Our patients and carers website can provide you with everything you need to know about aspergillosis.
This month we have talked a lot about the considerations for people who are classified as highly vulnerable to COVID-19 severe symptoms as they are being asked to stop shielding now that many countries are slowly lifting the lockdown..
Further information on this, and other COVID-19 information is available on aspergillosis.org.
Other meetings and support
We host a weekly video phone call (Software: Zoom) with around 4-8 patients and a member of National Aspergillosis Centre (NAC) staff twice each week. You can use a computer or mobile device to join the video but you need to register in advance. This meeting runs from 10:00-11:00 BST every Tuesday & Thursday and is also presented in our private Facebook group (see below).
There is an additional meeting on the first Friday of every month which normally takes place at NAC but for the period of time when we are unable to hold face-to-face meetings we are meeting on Zoom, using the same registration details.To receive a text reminder when each monthly meeting is approaching send us your mobile phone number (NB this doesn't operate in the US) to admin@aspergillus.org.uk.
Join our Private Facebook Groups for the Aspergillosis community
- Our Aspergillosis Support Facebook Group has over 2300 members and is a safe place to meet and talk to other people with aspergillosis.
- We also have a Facebook group for carers, friends and family of someone who is affected by the disease - join here
- To find our regional and international groups, search for 'aspergillosis' in Facebook.
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Jobs
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Clinical networks
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Conferences
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More and more conferences are switching to exclusively online presentation as COVID-19 continues to restrict travel and social contact throughout the world.
Asilomar has moved to 2022.
ECFG has moved to 2023
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See more groups and societies |
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Visit our sites
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(MFIG)
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(MRCM)
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(free online microscopy course)
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(fungal education for clinicians)
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Fungal Infection Trust, PO Box 482, Macclesfield, Cheshire SK10 9AR
