An international expert panel was convened to deliberate the management of azole-resistant aspergillosis. In culture-positive cases, in vitro susceptibility testing should always be performed if antifungal therapy is intended. Different patterns of resistance are seen, with multi-azole and pan-azole resistance more common than resistance to a single triazole. In confirmed invasive pulmonary aspergillosis due to an azole-resistant Aspergillus, the experts recommended a switch from voriconazole to liposomal amphotericin B (L-AmB; Ambisome(®)). In regions with environmental resistance rates of ≥10%, a voriconazole-echinocandin combination or L-AmB were favoured as initial therapy. All experts recommended L-AmB as core therapy for central nervous system aspergillosis suspected to be due to an azole-resistant Aspergillus, and considered the addition of a second agent with the majority favouring flucytosine. Intravenous therapy with either micafungin or L-AmB given as either intermittent or continuous therapy was recommended for chronic pulmonary aspergillosis due to a pan-azole-resistant Aspergillus. Local and national surveillance with identification of clinical and environmental resistance patterns, rapid diagnostics, better quality clinical outcome data, and a greater understanding of the factors driving or minimising environmental resistance are areas where research is urgently needed, as well as the development of new oral agents outside the azole drug class.

中文翻译：

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国际专家对耐唑类烟曲霉引起的感染的管理观点。

召集了一个国际专家小组来讨论耐唑类曲霉病的管理。在培养阳性的情况下，如果打算进行抗真菌治疗，则应始终进行体外药敏试验。观察到了不同的抗药性模式，与多唑和泛唑的抗药性比对单一三唑的抗药性更为普遍。在已确认的对唑类耐药的曲霉菌引起的侵袭性肺曲霉病中，专家建议从伏立康唑改为脂质体两性霉素B（L-AmB;Ambisome®）。在环境抗药性≥10％的地区，推荐使用伏立康唑-棘皮菌素组合或L-AmB作为初始治疗。所有专家都建议将L-AmB作为疑似归因于抗唑类曲霉菌的中枢神经系统曲霉病的核心疗法，并考虑添加第二种药物，其中多数药物有利于氟胞嘧啶。对于因泛唑耐药的曲霉菌所致的慢性肺曲霉病，建议采用米卡芬净或L-AmB的静脉治疗为间歇或连续治疗。迫切需要研究以及开发新的口服药物的领域，包括对临床和环境耐药性模式的识别，快速诊断，更好的临床结果数据以及对驱动或最小化环境耐药性的因素的更深入了解的地方和国家监督唑类药物以外的药物。对于因泛唑耐药的曲霉菌所致的慢性肺曲霉病，建议采用米卡芬净或L-AmB的静脉治疗为间歇或连续治疗。迫切需要研究以及开发新的口服药物的领域，包括对临床和环境耐药性模式的识别，快速诊断，更好的临床结果数据以及对驱动或最小化环境耐药性的因素的更深入了解的地方和国家监督唑类药物以外的药物。对于因泛唑耐药的曲霉菌所致的慢性肺曲霉病，建议采用米卡芬净或L-AmB的静脉治疗为间歇或连续治疗。迫切需要研究以及开发新的口服药物的领域，包括对临床和环境耐药性模式的识别，快速诊断，更好的临床结果数据以及对驱动或最小化环境耐药性的因素的更深入了解的地方和国家监视唑类药物以外的药物。