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ESCMID-EFISG Survey on Diagnostic and Therapeutic Capacity for Invasive Fungal Infections in Belgium, the Netherlands, and Luxembourg: A Focus on High Azole Resistance

Summary

This survey examined how well hospitals in Belgium, the Netherlands, and Luxembourg can diagnose and treat serious fungal infections, especially in patients whose immune systems are weakened. The researchers found that while most hospitals have good access to testing and antifungal medications, some important tests are still missing, and many hospitals send samples to other facilities for testing, which can delay treatment. Since this region has unusually high rates of fungal infections that resist common antifungal drugs, improving access to advanced diagnostic tests is crucial for patient survival.

Background

Invasive fungal infections (IFI) are major clinical challenges with high morbidity and mortality, particularly in immunocompromised patients. The incidence of IFI is rising globally due to increasing immunosuppressive conditions and aging populations. The Benelux region is characterized by high rates of azole-resistant Aspergillus fumigatus, ranging from 7-13%.

Objective

This survey evaluates the diagnostic and therapeutic capacity for invasive fungal infections in Belgium, the Netherlands, and Luxembourg, with particular focus on azole resistance. The study aims to assess availability of microbiology labs, diagnostic methods, antifungal drugs, and therapeutic drug monitoring across the Benelux region.

Results

Of 32 hospitals surveyed (19 from Belgium, 12 from Netherlands, 1 from Luxembourg), antifungal susceptibility testing was available in 91% of institutions. Aspergillus PCR testing was available in 63% of Belgian centers versus 92% in Netherlands. Mucorales PCR was available in only 56% of centers. Amphotericin B was unavailable in 16% of centers. Significantly more testing was outsourced in Belgium compared to Netherlands (p<0.001).

Conclusion

While antifungal susceptibility testing is widely available in Belgium and the Netherlands, implementation of specific tests for detecting azole resistance is not yet universal. Mucorales PCR testing availability is limited despite its clinical importance. High rates of test outsourcing in Belgium may delay diagnosis and impact patient outcomes. Improvements in reimbursement policies and accessibility of diagnostic tests are needed in areas with high azole resistance.
  • Published in:Mycoses,
  • Study Type:Survey,
  • Source: PMID: 40650433, DOI: 10.1111/myc.70092
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