Passive Surveillance for Azole-ResistantAspergillus fumigatus, United States, 2011–2013

Abstract

A. fumigatus cyp51A–mediated resistance to azole drugs is rare in the United States.

First Detection of TR34 L98H and TR46 Y121F T289A Cyp51 Mutations in Aspergillus fumigatus Isolates in the United States

“…A previous study surveillance study of 1,026 clinical A. fumigatus isolates collected from various states across the United States did not find these mutations (22). Although the complete patient histories are not known, additional information is available for 3 of these 4 isolates.…”

“…These resistance mechanisms, which include TR34 L98H and TR46 Y121F T289A, have been linked to the environmental use of azoles in agriculture and the preservation of various materials (14,15), and they have been found in various countries, including many in Europe, India, China, Iran, Tanzania, and Australia (13,(16)(17)(18)(19)(20)(21). However, these mutations have not yet been reported in isolates collected in the United States (22). Our objective was to evaluate the Cyp51-associated mechanisms of azole resistance in a collection of A. fumigatus isolates from institutions across the United States.…”

High prevalence of clinical and environmental triazole-resistant Aspergillus fumigatus in Iran: is it a challenging issue?

“…Austria, Belgium, Denmark, France, Germany, the Netherlands, Norway, Spain and Turkey), the USA, South America and Asian countries (e.g. China, India, Iran, Japan and Kuwait), with an incidence rate of 3.3-38 % (Badali et al, 2013;Bader et al, 2013;Bueid et al, 2010;Burgel et al, 2012;Chowdhary et al, 2011;Chryssanthou, 1997;Howard et al, 2009;Lockhart et al, 2011;Mortensen et al, 2010;Pham et al, 2014;Seyedmousavi et al, 2013;Snelders et al, 2008;van der Linden et al, 2011;van Ingen et al, 2014). According to a recent international surveillance study on the clinical isolates of azole-resistant A. fumigatus, an incidence rate of 3.2 % was reported, which introduced a novel phase in the management of invasive aspergillosis (van der Linden et al, 2015).…”

Treatment of drug-resistantAspergillusinfection

“…In contrast to acquired resistance, no isogenic isolate with a wild-type phenotype has been detected in patients carrying an Aspergillus strain with TR34/L98H genetic alteration. Although demethylation inhibitor fungicides are also used in the USA, CYP51A mutations are not evident yet, possibly due to less use of fungicides compared to Europe and Asia [5].…”