Azole‐Resistant Aspergillosis: An Emerging Diagnostic and Therapeutic Challenge in Paediatrics

INTRODUCTION: Invasive aspergillosis (IA) represents one of the most frequent invasive fungal infections in paediatric patients with risk factors. An increase in cases of azole-resistant IA has been reported in adult patients. The aim of this study is to present a series of 11 cases of paediatric patients with this pathology. METHODS: A retrospective descriptive study including paediatric patients with probable or proven azole-resistant IA treated between January 2019 and June 2024 in four tertiary hospitals in Spain. RESULTS: Eleven cases are reported, all patients with risk factors for IA, mainly with haematopoietic stem cell transplantation (HCT) due to haematological malignancies and heart transplant in the early post-transplant period. These patients represent 22% of all proven or probable paediatric IA cases (n = 50) diagnosed in the study centres during the period. Five were previously receiving azole-based antifungal prophylaxis. The most frequently isolated species was Aspergillus fumigatus. Despite receiving at least partially active antifungals plus adjunctive treatment therapy from diagnosis, attributable mortality was high (8/11 patients). CONCLUSION: Azole-resistant IA should be suspected in paediatric patients with risk factors, especially if they show poor clinical course or have received azole prophylaxis. The performance of invasive tests, as well as species identification and resistance testing, is essential to optimise treatment. In breakthrough IA it should be considered empirical treatment with an antifungal from a different class than the one used for prophylaxis, alone or in combination.

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Journal
Mycoses
Published
2026-10-29
DOI
https://doi.org/10.1111/myc.70206
Primary Topic
Antifungal resistance and susceptibility
Type
article
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article

Azole‐Resistant Aspergillosis: An Emerging Diagnostic and Therapeutic Challenge in Paediatrics

Pere Soler‐Palacín, Carlos Daniel Grasa, Teresa Martín Gómez, Alfredo Maldonado-Barrueco et al.
Mycoses
Antifungal resistance and susceptibility
article

Azole‐Resistant Aspergillosis: An Emerging Diagnostic and Therapeutic Challenge in Paediatrics

Pere Soler‐Palacín, Carlos Daniel Grasa, Teresa Martín Gómez, Alfredo Maldonado-Barrueco, Natalia Mendoza‐Palomar, Yasmina Mozo, Concepción Mediavilla-Gradolph, Anna Creus‐Costa, Ana María Méndez-Echevarría, Elena María Rincón‐López, Marisa Navarro, Jesús Guinea, Begoña Carazo Gallego, María Pinyol-Sarrias, Diego Lozano-Durán
article en

Abstract

INTRODUCTION: Invasive aspergillosis (IA) represents one of the most frequent invasive fungal infections in paediatric patients with risk factors. An increase in cases of azole-resistant IA has been reported in adult patients. The aim of this study is to present a series of 11 cases of paediatric patients with this pathology. METHODS: A retrospective descriptive study including paediatric patients with probable or proven azole-resistant IA treated between January 2019 and June 2024 in four tertiary hospitals in Spain. RESULTS: Eleven cases are reported, all patients with risk factors for IA, mainly with haematopoietic stem cell transplantation (HCT) due to haematological malignancies and heart transplant in the early post-transplant period. These patients represent 22% of all proven or probable paediatric IA cases (n = 50) diagnosed in the study centres during the period. Five were previously receiving azole-based antifungal prophylaxis. The most frequently isolated species was Aspergillus fumigatus. Despite receiving at least partially active antifungals plus adjunctive treatment therapy from diagnosis, attributable mortality was high (8/11 patients). CONCLUSION: Azole-resistant IA should be suspected in paediatric patients with risk factors, especially if they show poor clinical course or have received azole prophylaxis. The performance of invasive tests, as well as species identification and resistance testing, is essential to optimise treatment. In breakthrough IA it should be considered empirical treatment with an antifungal from a different class than the one used for prophylaxis, alone or in combination.

MycosesVol. 69(11)
Universidad Complutense de Madrid (ES), Universitat Autònoma de Barcelona (ES), Hospital Universitario La Paz (ES), Instituto de Salud Carlos III (ES), Hospital General Universitario Gregorio Marañón (ES), Hospital Costa del Sol (ES), Centro de Investigación Biomédica en Red de Salud Mental (ES), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (ES), Vall d'Hebron Institut de Recerca (ES), Hospital La Paz Institute for Health Research (ES), Hospital Regional Universitario de Málaga (ES), Centro de Investigación Biomédica en Red (ES), Vall d'Hebron Hospital Universitari (ES), Centro de Investigación Biomédica en Red Enfermedades Infecciosas (ES), Instituto de Investigación Sanitaria Gregorio Marañón (ES), Camilo José Cela University (ES)
Openalex Percentile: Top 12%
Antifungal resistance and susceptibility
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