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Triazole resistance surveillance in Aspergillus fumigatus

Agustin Resendiz Sharpe1, Katrien Lagrou1, Jacques F Meis2,3

  • 1Department of Laboratory Medicine, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, Leuven, Belgium.

Medical Mycology
|March 15, 2018
PubMed

Insights

Triazole resistance in Aspergillus fumigatus is a growing global concern, often linked to the Cyp51A gene. Understanding its epidemiology and clinical impact is crucial for effective antifungal strategies.

Area of Science:

  • Medical Mycology
  • Antimicrobial Resistance
  • Infectious Diseases

Background:

  • Triazole resistance in Aspergillus fumigatus is an escalating global health issue.
  • Resistance mechanisms, primarily mutations in the Cyp51A gene, can arise from therapeutic or environmental azole exposure.
  • Current understanding of resistance epidemiology and clinical outcomes remains incomplete.

Purpose of the Study:

  • To address the increasing concern of triazole resistance in Aspergillus fumigatus.
  • To investigate the epidemiology and clinical implications of triazole resistance.
  • To establish international collaboration for surveillance and consensus definitions.

Main Methods:

  • Review of existing surveillance data on triazole resistance.
  • Analysis of resistance mutations, particularly in the Cyp51A gene.
  • Establishment of the ISHAM/ECMM Aspergillus Resistance Surveillance working group.

Main Results:

  • Triazole resistance is documented across six continents, with environmental resistance mutations being dominant in many regions.
  • The origins (local emergence vs. migration) of resistance traits are not fully elucidated.
  • Clinical outcomes for patients with resistant infections show conflicting results, potentially due to diagnostic delays or limited treatment options.

Conclusions:

  • There is an urgent need for comprehensive surveillance to determine the full extent of triazole resistance globally.
  • Further research is required to understand the clinical impact and optimize treatment for resistant Aspergillus fumigatus infections.
  • International collaboration and standardized definitions are essential for effective management and control of triazole resistance.

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