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Passive surveillance for azole-resistant Aspergillus fumigatus, United States, 2011-2013

Cau D Pham, Errol Reiss, Ferry Hagen

    Emerging Infectious Diseases
    |August 23, 2014
    PubMed

    Insights

    Azole resistance in Aspergillus fumigatus is a global concern. Surveillance in the United States found no evidence of the TR34/L98H azole-resistant mutation in clinical isolates.

    Area of Science:

    • Medical Mycology
    • Antimicrobial Resistance

    Background:

    • Azole antifungal drugs are crucial for treating invasive Aspergillus fumigatus infections.
    • Emergence of azole-resistant A. fumigatus strains, particularly those with mutations in the cyp51A gene, poses a significant public health threat globally.
    • The TR34/L98H mutation in the cyp51A gene is a well-documented mechanism of azole resistance.

    Observation:

    • A passive surveillance study was conducted across 22 US states from 2011-2013.
    • 1,026 clinical isolates of A. fumigatus were analyzed for the presence of the TR34/L98H mutation.
    • Minimum Inhibitory Concentrations (MICs) for itraconazole were assessed.

    Findings:

    • No clinical isolates of A. fumigatus harboring the TR34/L98H mutation were detected in the United States during the study period.
    • The study found generally low MICs of itraconazole among the surveyed A. fumigatus isolates.
    • This suggests limited circulation of this specific azole resistance mechanism in the US during 2011-2013.

    Implications:

    • The absence of the TR34/L98H mutation indicates that current azole antifungal therapies may remain effective against A. fumigatus in the US, unlike in regions where this mutation is prevalent.
    • Continued surveillance is essential to monitor for the potential introduction and spread of azole-resistant A. fumigatus strains in the United States.
    • Understanding the geographic distribution of resistance mechanisms is critical for guiding antifungal treatment strategies and public health interventions.

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