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Azole resistance in Aspergillus: an emerging problem?

E Vermeulen1, S Cooreman, J Maertens

  • 1Medical Diagnostic Sciences, UZ Leuven, Leuven, Belgium. edith.vermeulen@uzleuven.be

Acta Clinica Belgica
|November 30, 2012
PubMed

Insights

Emerging azole resistance in Aspergillus is a growing concern, causing treatment failures in invasive aspergillosis. Surveillance for resistant Aspergillus fumigatus strains is crucial, especially in environmental settings.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Azole antifungal resistance in Aspergillus species is an increasing global health threat.
  • This resistance is a significant cause of treatment failure in patients with invasive aspergillosis.
  • Understanding the epidemiology, clinical impact, and molecular mechanisms of Aspergillus azole resistance is critical.

Purpose of the Study:

  • To describe the multifaceted problem of azole resistance in Aspergillus.
  • To elucidate the epidemiological trends and clinical consequences of resistant Aspergillus infections.
  • To detail the molecular mechanisms underlying acquired and intrinsic azole resistance in Aspergillus species.

Main Methods:

  • Review of current literature on Aspergillus azole resistance.
  • Analysis of epidemiological data regarding resistant Aspergillus strains.
  • Examination of molecular mechanisms, including CYP51A mutations and naturally resistant species.

Main Results:

  • Resistance in Aspergillus can be acquired (e.g., CYP51A mutations) or intrinsic to certain species.
  • Environmental emergence of resistant Aspergillus fumigatus, particularly pan-azole resistance, is increasing in regions like the Netherlands.
  • Invasive aspergillosis treatment failure is linked to the presence of azole-resistant Aspergillus strains.
  • In-patient resistance development can occur in chronic Aspergillus infections, such as aspergilloma.

Conclusions:

  • Environmental surveillance for azole-resistant Aspergillus fumigatus is essential.
  • Clinical isolates from patients undergoing antifungal therapy should be tested for susceptibility.
  • Voriconazole remains a primary treatment for invasive aspergillosis, but resistance necessitates ongoing monitoring and susceptibility testing.

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