Background
Acquired azole resistance (AR) in Aspergillus fumigatus emphasizes the importance of the One Health multisectorial approach. The prevalence of azole-resistant A. fumigatus in the environment of Greece is unknown.
Methods
Between October 2016 and September 2017, a total of 716 soil samples were collected from 23 provinces and screened for AR using azole-containing agar plates. Recovered isolates were macro-/microscopically identified and colonies were counted. Azole susceptibility testing of A. fumigatus species complex (SC) isolates was performed (EUCAST E.DEF9.3.1). Azole-resistant A. fumigatus isolates were subjected to confirmatory molecular identification and sequencing of the cyp51A gene.
Results
No yeasts were recovered, while multiple moulds grew on 695 (97%) samples. Overall, zygomycetes (most non-Mucor genera) grew on 432 (60%) samples, while Aspergillus spp. grew on 500 (70%) [410 (57%) Aspergillus niger SC; 120 (17%) Aspergillus terreus SC; 101 (14%) A. fumigatus SC; 34 (5%) Aspergillus flavus SC]. The mean ± SD soil load of Aspergillus spp. was 2.23 ± 0.41 log10 cfu/g (no differences among species). No azole-resistant non-A. fumigatus spp. isolate was detected. Itraconazole, voriconazole, isavuconazole and posaconazole MIC50/MIC90 (MIC range) of A. fumigatus SC strains were 0.25/0.5 (0.25 to >8), 0.5/1 (0.25 to >8), 1/1 (0.125 to >8) and 0.06/0.125 (0.06–1) mg/L, respectively. Overall, 1/500 (0.2%) of Aspergillus isolates, and 1/101 (1%) of A. fumigatus SC isolates, was pan-azole-resistant (itraconazole, voriconazole, isavuconazole and posaconazole MIC >8, >8, >8 and 1 mg/L, respectively). The resistant isolate was recovered from organically grown raisin grapes treated with homemade compost and it was an A. fumigatus sensu stricto isolate harbouring the TR46/Y121F/T289A mutation. The soil’s load was higher compared with azole-susceptible strains (3.74 versus 2.09 log10 cfu/g).
Conclusions
This is the first known report of environmental pan-azole-resistant A. fumigatus in Greece. Since data on Greek clinical isolates are lacking, this finding must alarm the systematic local surveillance of AR in medical settings.
A large number of apex predator samples are available in European research collections, environmental specimen banks and natural history museums that could be used in chemical monitoring and regulation. Apex predators bioaccumulate pollutants and integrate contaminant exposure over large spatial and temporal scales, thus providing key information for risk assessments. Still, present assessment practices under the different European chemical legislations hardly use existing chemical monitoring data from top predators. Reasons include the lack of user-specific guidance and the fragmentation of data across time and space. The European LIFE APEX project used existing sample collections and applied state-of-the-art target and non-target screening methods, resulting in the detection of > 4,560 pollutants including legacy compounds. We recommend establishing infrastructures that include apex predators as an early warning system in Europe. Chemical data of apex species from freshwater, marine and terrestrial compartments should become an essential component in future chemical assessment and management across regulations, with the purpose to (1) validate registration data with ‘real world’ measurements and evaluate the predictability of current models; (2) identify and prioritise hazardous chemicals for further assessment; (3) use data on food web magnification as one line of evidence to assess biomagnification; (4) determine the presence of (bio)transformations products and typical chemical mixtures, and (5) evaluate the effectiveness of risk management measures by trend analysis. We highlight the achievements of LIFE APEX with regard to novel trend and mixture analysis tools and prioritisation schemes. The proposed advancements complement current premarketing regulatory assessments and will allow the detection of contaminants of emerging concern at an early stage, trigger risk management measures and evaluations of their effects with the ultimate goal to protect humans and the environment. This is the second policy brief of the LIFE APEX project.
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