Azole-Resistance in Aspergillus terreus and Related Species: An Emerging Problem or a Rare Phenomenon?

Tamara Zoran1, Bettina Sartori1, Laura Sappl1

  • 1Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria.

Insights

Invasive mold infections caused by Aspergillus species are a significant threat. This study found that while Aspergillus terreus is prevalent, 5.4% of strains show resistance to posaconazole, a key antifungal drug.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Invasive mold infections, particularly those caused by Aspergillus species, are a major cause of mortality in immunocompromised individuals.
  • Aspergillus section Fumigati and Terrei are the most frequent etiological agents, but the prevalence of Aspergillus terreus and related species, along with their azole resistance, requires further investigation.

Purpose of the Study:

  • To determine the frequency of Aspergillus terreus and phenotypically related species in clinical isolates.
  • To assess the antifungal susceptibility of these isolates to posaconazole, voriconazole, and itraconazole.
  • To correlate azole resistance phenotypes with specific mutations in the cyp51A gene.

Main Methods:

  • Molecular identification of 498 Aspergillus terreus and related isolates using beta-tubulin gene sequencing.
  • Antifungal susceptibility testing against posaconazole, voriconazole, and itraconazole according to EUCAST clinical breakpoints.
  • Genomic analysis to identify point mutations in the cyp51A gene associated with drug resistance.

Main Results:

  • Aspergillus terreus was the predominant species (86.8%), followed by A. citrinoterreus (8.4%).
  • Overall azole resistance was detected in 5.4% of isolates; 6.2% of A. terreus sensu stricto were posaconazole-resistant, with geographic variations.
  • Posaconazole resistance was linked to M217T/V mutations in the cyp51A gene, while resistance to voriconazole was rare and itraconazole resistance was absent.

Conclusions:

  • Aspergillus terreus and A. citrinoterreus are the most common species causing invasive infections.
  • A significant proportion of A. terreus sensu stricto isolates exhibit posaconazole resistance, necessitating careful monitoring and treatment strategies.
  • Antifungal resistance patterns vary geographically, highlighting the importance of regional surveillance for effective management of invasive aspergillosis.

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