Clinical and Microbiological Characteristics of Aspergillosis at a Chinese Tertiary Teaching Hospital

Chenlu Xiao; Dan Qiao; Lijuan Xiong; Wenjie Tian; Dongjiang Wang; Shuwen Deng; Jian Guo

doi:10.2147/IDR.S391069

Clinical and Microbiological Characteristics of Aspergillosis at a Chinese Tertiary Teaching Hospital

Infect Drug Resist. 2022 Dec 11:15:7249-7257. doi: 10.2147/IDR.S391069. eCollection 2022.

Authors

Chenlu Xiao^#^{1

2}, Dan Qiao^#¹, Lijuan Xiong^#³, Wenjie Tian⁴, Dongjiang Wang⁴, Shuwen Deng⁵, Jian Guo⁴

Affiliations

¹ Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
² Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
³ Department of Laboratory Medicine, Second Affiliated Hospital of Traditional Chinese Medicine of Guizhou University, Guizhou, People's Republic of China.
⁴ Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
⁵ Department of Medical Microbiology, People's Hospital of Suzhou New District, Suzhou, Jiangsu, People's Republic of China.

^# Contributed equally.

Abstract

Background: Aspergillus spp. infection in immunocompromised patients results in increasing morbidity and mortality. This study investigated clinical and microbiological characteristics of aspergillosis in a Chinese tertiary teaching hospital.

Methods: A total of 114 patients with aspergillosis were included over a 5-year period at Ruijin Hospital. In sum, 114 Aspergillus strains were isolated and identified at species level using matrix-assisted laser desorption ionization time-of-flight mass spectrometry, confirmed by ITS gene region and β-tubulin (BenA) gene sequencing. Sensititre YeastOne was used in vitro to test susceptibility to antifungal drugs: amphotericin B, itraconazole, voriconazole, posaconazole, isavuconazole, micafungin, anidulafungin, and caspofungin.

Results: The median age of the patients was 61 (19) years, men accounted for 53.5% (n=61) of the sample, about 64% were immunocompromised, and 36% had underlying diseases. Pulmonary diseases accounted for 27.2%. Aspergillus isolates were mainly isolated from sputum (n=42, 36.8%). Antifungal therapy was administered to 106 (93.0%) patients and voriconazole (n=76, 66.7%) was the most frequently used as empirical therapy. Aspergillus fumigatus (n=69, 60.5%) was the most common species. There was a 73.7% concordance between MALDI-TOF MS and molecular identification. All Aspergillus isolates showed good susceptibility to anidulafungin and caspofungin.

Conclusion: Immunocompromised patients are an at-risk population for aspergillosis, and voriconazole was used as empirical therapy in Ruijin Hospital, China. A. fumigatus was the predominant Aspergillus species causing aspergillosis, and A. flavus - as non-A. fumigatus species are increasing - the second-leading cause of aspergillosis. Anidulafungin and caspofungin were the most active in vitro against the Aspergillus isolates tested. The MALDI-TOF MS method showed good accuracy for identification of common Aspergillus spp. In vitro antifungal-susceptibility testing is crucially important for decisions on effective therapy with aspergillosis.

Keywords: Aspergillus spp.; MALDI-TOF MS; antifungal susceptibility; aspergillosis; epidemiology; molecular identification.

Grants and funding

This work was supported by grants from the Key Discipline of Public Health in Shanghai (GWV-10.1-XK04) and Excellent Technology Leader in Shanghai (20XD1434500), partly supported by a grant from Suzhou Bureau of Science and technology (SKY2022037) and from the People’s Hospital of SND (SGY2019D02).