Azole-Resistant Aspergillosis: An Emerging Diagnostic and Therapeutic Challenge in Paediatrics.
20 affiliations
- 1Paediatric Infectious Diseases and Immunodeficiencies Unit, Children's Hospital, Vall D'hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain.
- 2Infection and Immunity in Children, Vall D'hebron Institut de Recerca (VHIR), Vall D'hebron Barcelona Hospital Campus, Barcelona, Spain.
- 3Paediatric Infectious Diseases Department, Hospital Universitario La Paz (Madrid), Madrid, Spain.
- 4Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain.
- 5Centro de Investigacion en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.
- 6Paediatric Infectious Diseases and Immunodeficiencies, Málaga Regional University Hospital, Málaga, Spain.
- 7Paediatric Infectious Diseases Unit, Gregorio Marañon General Hospital, Madrid, Spain.
- 8Centro de Investigación Biomédica en Red del Instituto de Salud Carlos III (CIBERINFEC), Madrid, Spain.
- 9Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain.
- 10Clinical Microbiology Department, Hospital Universitario La Paz (Madrid), Madrid, Spain.
- 11Paediatric Hemato-Oncology Department, Hospital Universitario La Paz (Madrid), Madrid, Spain.
- 12Paediatric Department, Hospital Costa del Sol, Málaga, Spain.
- 13Universidad Complutense de Madrid (UCM), Madrid, Spain.
- 14Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
- 15Faculty of Health Sciences - HM Hospitals, Universidad Camilo José Cela, Madrid, Spain.
- 16CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.
- 17Microbiology Department, Málaga Regional University Hospital, Málaga, Spain.
- 18Universitat Autònoma de Barcelona (UAB), Bellaterra, Catalonia, Spain.
- 19Microbiology Department, Vall D'hebron Hospital Campus, Barcelona, Catalonia, Spain.
- 20Microbiology, Vall D'hebron Institut de Recerca (VHIR), Vall D'hebron Barcelona Hospital Campus, Barcelona, Spain.
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.
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BibTeX
@article{mendozapalomar2026azoleresistant,
title = {{Azole-Resistant Aspergillosis: An Emerging Diagnostic and Therapeutic Challenge in Paediatrics.}},
author = {Natalia Mendoza-Palomar and Carlos Grasa Lozano and Begoña Carazo-Gallego and Elena María Rincón-López and Maria Pinyol-Sarrias and Anna Creus-Costa and Ana Méndez-Echevarría and Alfredo Maldonado-Barrueco and Yasmina Mozo and Diego Lozano-Durán and Maria Luisa Navarro Gómez and Jesús Guinea and Maria Concepción Mediavilla Gradolph and Pere Soler-Palacín and María Teresa Martín-Gómez},
journal = {Mycoses},
year = {2026},
month = oct,
doi = {10.1111/myc.70206},
url = {https://europepmc.org/article/MED/42958853},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Azole-Resistant Aspergillosis: An Emerging Diagnostic and Therapeutic Challenge in Paediatrics.
AU - Natalia Mendoza-Palomar
AU - Carlos Grasa Lozano
AU - Begoña Carazo-Gallego
AU - Elena María Rincón-López
AU - Maria Pinyol-Sarrias
AU - Anna Creus-Costa
AU - Ana Méndez-Echevarría
AU - Alfredo Maldonado-Barrueco
AU - Yasmina Mozo
AU - Diego Lozano-Durán
AU - Maria Luisa Navarro Gómez
AU - Jesús Guinea
AU - Maria Concepción Mediavilla Gradolph
AU - Pere Soler-Palacín
AU - María Teresa Martín-Gómez
PY - 2026
DA - 2026/10/29
JO - Mycoses
DO - 10.1111/myc.70206
UR - https://europepmc.org/article/MED/42958853
AB - 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.
SN - 0933-7407
SN - 1439-0507
ER -