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
Description: 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."
Measure: Treatment success Time: 6 weeks after diagnosis of proven or probable invasive aspergillosisDescription: The proportion of non-survivors. Discharge against medical advice and in critical condition and lost to follow up will categorized as mortality.
Measure: All-cause mortality Time: 6 weeks after diagnosis of proven or probable invasive aspergillosisDescription: The proportion of non-survivors. Discharge against medical advice and in critical condition and lost to follow up will categorized as mortality.
Measure: All-cause mortality Time: 12 weeks after diagnosis of proven or probable invasive aspergillosisDescription: The proportion of patients with breakthrough mold infections
Measure: Breakthrough mold infections Time: 6 weeks after diagnosis of proven or probable invasive aspergillosisDescription: 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
Measure: Breakthrough invasive fungal diseases Time: 12 weeks after diagnosis of proven or probable invasive aspergillosisDescription: The proportion of patients with complete response or partial response.
Measure: Treatment success Time: 12 weeks after diagnosis of proven or probable invasive aspergillosisCase-Only
There is one SNP
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. --- L98H ---