Azole resistance survey on clinical Aspergillus fumigatus isolates in Spain

Abstract

showing azole resistance according to the EUCAST 9.3.2 methodology were molecularly identified and the cyp51A gene was studied in A. fumigatus sensu stricto isolates. Results: Eight hundred and forty-seven isolates from 725 patients were collected in 29 hospitals (A. fumigatus sensu stricto (n ¼ 828) and cryptic species (n ¼ 19)). Isolates were mostly from the lower respiratory tract (94.0%; 797/847). Only cryptic species were amphotericin B resistant. Sixty-three (7.4%) out of the 847 isolates were resistant to 1 azole(s). Azole resistance was higher in cryptic species than in A. fumigatus sensu stricto (95%, 18/19 vs. 5.5%, 45/828); isavuconazole was associated to the lowest number of non-wild type isolates. The dominant mechanism of resistance was the presence of TR 34 -L98H substitutions (n ¼ 24 out of 63). Out of the 725 patients, 48 (6.6%) carried either cryptic species (n ¼ 14) or A. fumigatus sensu stricto (n ¼ 34; 4.7%) resistant isolates. Aspergillus fumigatus sensu stricto harbouring either the TR 34 -L98H (n ¼ 19) or TR 46 /Y121F/T289A (n ¼ 1) mutations were detected in patients in hospitals located at 7/24 studied cities. Discussion: Of the patients, 6.6% carry azole-resistant A. fumigatus sensu lato isolates in Spain. TR 34 -L98H is the dominant cyp51A gene substitutions, although its presence is not widespread.

Azole resistance in Aspergillus isolates by different types of patients and correlation with environment ‐ An Italian prospective multicentre study (ARiA study)

“…These values are higher than those of the SCARE study (2%), conducted in Italy between 2009 and 2010, 24 when prevalence was probably underestimated. Prevalence data from the present study is in line with those reported by Escribado et al 23 in Spain, and is slightly above values reported in other European Countries as Belgium (5.5%) 25 and Netherland (5.3%) 26 . Prevalence rate seems to be lower in some Asian countries (in Iran and India the prevalence was around 4.2% and 1.9% respectively 27,28 ), as well as in other continents, as USA (1.4%) 29 or Australia (2%) 30 …”

Changing Epidemiology of Invasive Fungal Disease in Allogeneic Hematopoietic Stem Cell Transplantation

“…For example, Aspergillus terreus is typically less susceptible to amphotericin B. Additionally, the use of molecular tools has permitted the description of new cryptic species among different Aspergillus species complexes. Remarkably, these species commonly exhibit innate, high-level resistance to multiple antifungal agents, including amphotericin B and the triazoles [47,48]. This observation underlines the importance of identifying to the species level and performing antifungal resistance testing, especially in those cases wherein a lack of response to initial therapy is present.…”

Detection of azole resistance in Aspergillus fumigatus complex isolates using MALDI-TOF mass spectrometry

“…The isolates (n=868) used for this study were from a recent national survey on azole resistance conducted in Spain (14). Additionally, we included isolates showing azole resistance or being cryptic species that were collected during that study but excluded from the analysis as they did not fulfil selection criteria.…”

“…The identification was carried out from colonies grown on Sabouraud agar plates incubated for 1-3 days at 35ºC, as described before (14). Proteins were extracted from fungal isolates prior MALDI-TOF MS analysis by disrupting the fungal wall.…”