Prospective multicentre study on azole resistance in Aspergillus isolates from surveillance cultures in haematological patients in Italy

Prigitano, Anna; Esposto, Maria Carmela; Grancini, Anna; Passera, Marco; Paolucci, Marina; Stanzani, Marta; Sartor, Assunta; Candoni, Anna; Pitzurra, Lucia; Innocenti, Patrizia; Micozzi, Alessandra; Cascio, Giuliana Lo; Delia, Mario; Mikulska, Małgorzata; Ossi, C.; Fontana, Carla; Pizzolante, M.; Gelmi, M; Cavanna, C.; Lallitto, Fabiola; Amato, Gerardino; Vella, Antonietta; Pagano, Livio; Bandettini, Roberto; Lorenzis, Gabriella De; Cogliati, Massimo; Romanò, Luisa; Tortorano, A.M.

doi:10.1016/j.jgar.2020.01.016

Cited by 7 publications

(11 citation statements)

References 29 publications

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“…In our study, among patients harbouring an azole‐resistant A fumigatus strain, none had an underlying haematological disease, confirming the low prevalence values of azole‐resistance recently reported in the same population (1.48%) 5 …”

Section: Discussionsupporting

confidence: 90%

“…However, excluding CF population, a high azole‐resistance rate (10.2%) was confirmed among patients admitted to the same hospital where CFML is located 5 . It is likely that the building renovations, which for years have involved the hospital, represent an important source of spread of fungal spores, also leading to an increase in resistant strains.…”

Section: Discussionmentioning

confidence: 94%

“…The present Italian observational prospective multicentre study aimed to evaluate the prevalence of Aspergillus azole resistance not only in CF or haematological patients, as in previous Italian studies, 4,5 but in the full spectrum of diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Azole‐resistance in Aspergillus spp. is an emerging problem in many countries of the world including Italy, where Aspergillus fumigatus resistant strains have been isolated from the environment 1,2 and from both naïve and on antifungal therapy patients 3–5 …”

Section: Introductionmentioning

confidence: 99%

“…A wide range of frequency values of azole‐resistance in A fumigatus in different patient populations has been observed worldwide: from 4.5% to 26% of resistant strains in Intensive Care Unit (ICU) patients, from 1% to 24.6% in haematological patients and up to 8.2% in cystic fibrosis (CF) patients 4,5,8‐11 …”

Section: Introductionmentioning

confidence: 99%

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

Prigitano

Esposto

Grancini

et al. 2021

Mycoses

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Background A wide range of frequency of azole‐resistance in A fumigatus in different patient populations worldwide was observed threatening to reduce therapeutic options. Objectives Estimate the prevalence of azole‐resistance, investigate the molecular mechanisms of resistance, compare the genotypes of resistant clinical isolates with those from the surrounding environment. Methods Aspergillus isolates were collected by seven Italian hospital microbiology laboratories. Strains were isolated from different clinical samples from unselected patients. The azole‐resistance was evaluated using screening test and microdilution EUCAST method. The molecular mechanism of resistance was performed sequencing the cyp51A gene. Resistant isolates were genotyped by microsatellite analysis and their profiles compared with those of azole‐resistant isolates from previous Italian studies. Results 425 Aspergillus isolates from 367 patients were analysed. The azole‐resistance rates were 4.9% and 6.6% considering all Aspergillus spp. isolates and the A fumigatus sensu stricto, respectively. All resistant isolates except one were from a single hospital. Two rare azole‐resistant species were identified: A thermomutatus and A lentulus. The predominant resistance mechanism was TR34/L98H. No correlation between the clinical resistant strains and environmental isolates from patients’ home/work/ward was observed. The analysis of the molecular correlation between the resistant clinical strains collected in the present study and those of environmental and clinical origin collected in previous Italian studies reveals a progressive diversification of azole‐resistant genotypes starting from a founder azole‐resistant genotype. Conclusions This study confirms the trend of azole‐resistance rate in Italy, showing a geographical difference. Data reinforce the importance of surveillance programmes to monitor the local epidemiological situation.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Prigitano

Esposto

Grancini

et al. 2021

Mycoses

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Invasive Aspergillosis and the Impact of Azole-resistance

Bosetti

Neofytos

2023

Curr Fungal Infect Rep

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Purpose of Review IA (invasive aspergillosis) caused by azole-resistant strains has been associated with higher clinical burden and mortality rates. We review the current epidemiology, diagnostic, and therapeutic strategies of this clinical entity, with a special focus on patients with hematologic malignancies. Recent Findings There is an increase of azole resistance in Aspergillus spp. worldwide, probably due to environmental pressure and the increase of long-term azole prophylaxis and treatment in immunocompromised patients (e.g., in hematopoietic stem cell transplant recipients). The therapeutic approaches are challenging, due to multidrug-resistant strains, drug interactions, side effects, and patient-related conditions. Summary Rapid recognition of resistant Aspergillus spp. strains is fundamental to initiate an appropriate antifungal regimen, above all for allogeneic hematopoietic cell transplantation recipients. Clearly, more studies are needed in order to better understand the resistance mechanisms and optimize the diagnostic methods to identify Aspergillus spp. resistance to the existing antifungal agents/classes. More data on the susceptibility profile of Aspergillus spp. against the new classes of antifungal agents may allow for better treatment options and improved clinical outcomes in the coming years. In the meantime, continuous surveillance studies to monitor the prevalence of environmental and patient prevalence of azole resistance among Aspergillus spp. is absolutely crucial.

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Azole resistance in Aspergillus species: promising therapeutic options

Pasula

Chandrasekar

2021

Expert Opinion on Pharmacotherapy

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Prospective multicentre study on azole resistance in Aspergillus isolates from surveillance cultures in haematological patients in Italy

Cited by 7 publications

References 29 publications

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

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

Invasive Aspergillosis and the Impact of Azole-resistance

Azole resistance in Aspergillus species: promising therapeutic options

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