Surveillance of Azole Resistance in Aspergillus Isolates in Taiwan

Surveillance of Azole Resistance in Aspergillus

Primary objectives:

1. To investigate the prevalence of azole resistance in Aspergillus clinical isolates collected in participating hospitals in Taiwan
2. To investigate the prevalence of azole resistance in Aspergillus environmental isolates in Taiwan
3. To characterize the molecular mechanisms of azole resistance in Aspergillus isolates in Taiwan
4. To investigate the clonality of Aspergillus clinical and environmental isolates in Taiwan
5. To describe the genetic relationships between local resistant strains with global strains

Secondary objective:

1. To describe the clinical characteristics and treatment outcome of patients with proven or probable invasive aspergillosis
2. To evaluate the clinical impact of azole resistance in patients with proven or probable invasive aspergillosis in a case-control study

Study Overview

• Status: Unknown
• Conditions: Infection; Aspergillus

Detailed Description

Cumulative evidence described the emergence and geographical expansion of azole-resistant Aspergillus fumigatus associated with azole treatment failure. Multiple amino acid substitutions in the cyp51A gene have been described to be associated with azole resistance that emerges during azole treatment, while a resistance mechanism, TR34/L98H mutation in cyp51A, has been linked to the agricultural use of azole fungicides in Europe, which have also been widely used in Taiwan for years. The current prevalence of azole-resistant Aspergillus isolates and mechanisms of azole resistance in Taiwan is not clear. Considering the potential of geographic migration of resistant isolates from neighboring countries and the possibility of emergence of locally revolved resistant strains, this 2-year multi-center project aims to investigate the prevalence rate of azole resistance in Aspergillus clinical and environmental isolates, to determine the molecular mechanisms of azole resistance, and to describe the clinical characteristics and treatment outcome of Aspergillus diseases in Taiwan. Clinical and environmental Aspergillus isolates will be collected and examined, and clinical data from patients with Aspergillus diseases or colonization will be retrieved and analyzed. Through this study the investigators anticipate increase in awareness of prevalence and impact of azole resistance in patient safety in participating hospitals. In addition, the investigators may update Taiwan treatment guideline for aspergillosis on the basis of these evidence and knowledge.

• Study Type: Observational
• Enrollment (Anticipated): 200

Contacts and Locations

Study Locations

• Taiwan
  • Taipei, Taiwan, 100
    • Recruiting
    • National Taiwan University Hospital
    • Contact: Chen Yee-Chun, MD, PhD; Phone Number: 65908 886-2-23123456; Email: yeechunchen@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

A total of 10 hospitals located in different geographic location of Taiwan will be invited to participate this project. These hospitals are selected based on three criteria: better quality of routine microbiology laboratory (not reference laboratory), one or more physicians or microbiologists who are interested in medical mycology, and geographic location of the hospitals.

Description

For primary objectives

Inclusion Criteria:

• Patients with one or more clinical specimens culture positive of Aspergillus

Exclusion Criteria:

• Is not a human pathogen of Aspergillus
• no clinical data available

For secondary objectives (a case-control study in a 1:4 ratio)

Inclusion Criteria:

• patients with proven or probable invasive aspergillosis

Case patients: patients infected by azole-resistant isolates Control patients: patients infected by azole-susceptible isolates

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Treatment success	The proportion of patients with complete response or partial response according to the definition described in "Segal BH, Herbrecht R, Stevens DA, Ostrosky-Zeichner L, Sobel J, Viscoli C, et al. Defining responses to therapy and study outcomes in clinical trials of invasive fungal diseases: Mycoses Study Group and European Organization for Research and Treatment of Cancer consensus criteria. Clin Infect Dis. Sep 1 2008;47(5):674-683."	6 weeks after diagnosis of proven or probable invasive aspergillosis

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
All-cause mortality	The proportion of non-survivors. Discharge against medical advice and in critical condition and lost to follow up will categorized as mortality.	6 weeks after diagnosis of proven or probable invasive aspergillosis
All-cause mortality	The proportion of non-survivors. Discharge against medical advice and in critical condition and lost to follow up will categorized as mortality.	12 weeks after diagnosis of proven or probable invasive aspergillosis
Breakthrough mold infections	The proportion of patients with breakthrough mold infections	6 weeks after diagnosis of proven or probable invasive aspergillosis
Breakthrough invasive fungal diseases	The proportion of patients with breakthrough invasive fungal diseases defined as occurrence of a proven or probable invasive fungal diseases according to EORTC/MSG revised definitions while on systemic antifungal therapy or within 15 days of discontinuation of antifungal use	12 weeks after diagnosis of proven or probable invasive aspergillosis
Treatment success	The proportion of patients with complete response or partial response.	12 weeks after diagnosis of proven or probable invasive aspergillosis

Collaborators and Investigators

• Sponsor: National Taiwan University Hospital
• Collaborators: National Health Research Institutes, Taiwan
• Investigators: Study Director: WHO, ICMJE WHO and ICMJE, WHO and ICMJE

Study record dates

Study Major Dates

• Study Start: July 1, 2016
• Primary Completion (Anticipated): December 1, 2018
• Study Completion (Anticipated): December 1, 2018

Study Registration Dates

• First Submitted: November 21, 2016
• First Submitted That Met QC Criteria: January 15, 2017
• First Posted (Estimate): January 18, 2017

Study Record Updates

• Last Update Posted (Estimate): January 18, 2017
• Last Update Submitted That Met QC Criteria: January 15, 2017
• Last Verified: January 1, 2017

More Information

Terms related to this study

• Keywords: Aspergillus; Azole resistance; Antifungal susceptibility
• Additional Relevant MeSH Terms: Infections; Bacterial Infections and Mycoses; Mycoses; Aspergillosis
• Other Study ID Numbers: 201605098RIPA

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED