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Antifungal Susceptibility of the Aspergillus viridinutans Complex: Comparison of Two In Vitro Methods

Pavlina Lyskova1,2, Vit Hubka3,4, Lucie Svobodova5

  • 1Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic pavlina.lyskova@zuusti.cz.

Antimicrobial Agents and Chemotherapy
|February 14, 2018
PubMed

Insights

Cryptic Aspergillus species, like those in the Aspergillus viridinutans complex, cause invasive aspergillosis and often resist antifungals. This study evaluated their antifungal susceptibility, finding resistance to voriconazole and itraconazole but susceptibility to posaconazole and echinocandins.

Area of Science:

  • Medical Mycology
  • Antimicrobial Resistance
  • Clinical Microbiology

Background:

  • Cryptic species within the Aspergillus genus, particularly the Aspergillus viridinutans species complex, are increasingly recognized as significant pathogens causing invasive aspergillosis.
  • These cryptic species often exhibit intrinsic resistance to commonly used antifungal agents, posing a therapeutic challenge.

Purpose of the Study:

  • To evaluate the in vitro antifungal susceptibilities of environmental and clinical isolates belonging to the Aspergillus viridinutans species complex.
  • To compare the performance of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) reference method with Sensititre YeastOne (YO) panels for determining these susceptibilities.

Main Methods:

  • DNA sequencing of the calmodulin gene was used to identify 90 isolates from the Aspergillus viridinutans species complex.
  • Antifungal susceptibility testing was performed using the EUCAST method against seven agents: voriconazole, posaconazole, itraconazole, amphotericin B, anidulafungin, micafungin, and caspofungin.
  • Results from the EUCAST method were compared with those obtained using Sensititre YeastOne (YO) panels read at 48 and 72 hours.

Main Results:

  • The majority of isolates showed elevated minimum inhibitory concentrations (MICs) for voriconazole (geometric mean [GM] MIC, 4.46 mg/liter) and itraconazole (GM MIC, 9.85 mg/liter), with variable susceptibility to amphotericin B (GM MIC, 2.5 mg/liter).
  • Posaconazole and echinocandins demonstrated low MICs and minimum effective concentrations, respectively.
  • Overall agreement between EUCAST and YO panels was 67% at 48 hours and 82% at 72 hours, with high agreement for amphotericin B, voriconazole, and posaconazole, but very low agreement for itraconazole.

Conclusions:

  • The Aspergillus viridinutans species complex frequently displays resistance to voriconazole and itraconazole, highlighting the need for accurate species identification and susceptibility testing.
  • Posaconazole and echinocandins appear to be more reliable therapeutic options against these cryptic Aspergillus species.
  • The EUCAST method provides a reliable basis for susceptibility testing, although agreement with YO panels varies significantly by antifungal agent and species, particularly for itraconazole.
Keywords:
Aspergillus felisAspergillus udagawaeamphotericin Bcryptic speciesechinocandinsitraconazoleposaconazolevoriconazole

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