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Molecular Identification and Susceptibility Testing of Molds Isolated in a Prospective Surveillance of Triazole

Ana Alastruey-Izquierdo1,2, Laura Alcazar-Fuoli3,2, Olga Rivero-Menéndez3

  • 1Instituto Salud Carlos III, National Centre for Microbiology, Madrid, Spain anaalastruey@isciii.es.

Antimicrobial Agents and Chemotherapy
|June 27, 2018
PubMed

Insights

Antifungal resistance is a growing concern. This study found low azole resistance in Aspergillus fumigatus but higher resistance in other mold species, highlighting the importance of identifying cryptic species.

Area of Science:

  • Medical Mycology
  • Antimicrobial Resistance
  • Molecular Biology

Background:

  • Antifungal resistance is a significant global health threat, driven by emerging resistant fungal species and acquired resistance in susceptible ones.
  • Previous Spanish studies indicated 10–12.7% azole resistance in molds, with no secondary resistance detected in Aspergillus fumigatus.
  • The emergence of antifungal resistance necessitates continuous monitoring and characterization of resistance mechanisms in clinically relevant fungi.

Purpose of the Study:

  • To investigate the prevalence and characteristics of azole resistance in fungal isolates from Spanish tertiary hospitals.
  • To identify specific resistance mechanisms, including mutations in the cyp51A gene, in azole-resistant Aspergillus fumigatus strains.
  • To assess the antifungal resistance profiles of various fungal genera, including cryptic species.

Main Methods:

  • Utilized itraconazole (ITZ)-supplemented medium to selectively isolate resistant fungal strains.
  • Collected 493 fungal isolates from 10 Spanish tertiary hospitals for molecular identification and antifungal susceptibility testing.
  • Sequenced the cyp51A gene in azole-resistant Aspergillus fumigatus strains to identify resistance-associated mutations.

Main Results:

  • Aspergillus was the most common genus (80.3%), followed by Scedosporium-Lomentospora (7.9%), Penicillium-Talaromyces (4.5%), Fusarium (2.6%), and Mucorales (1%).
  • Antifungal resistance was observed in Scedosporium-Lomentospora, Fusarium, Talaromyces, and Mucorales species.
  • Three Aspergillus fumigatus sensu stricto strains exhibited azole resistance; two had the TR34+L98H mechanism, and one showed no cyp51A mutations. Cryptic species constituted over 10% of isolates with broader resistance.

Conclusions:

  • Azole resistance in Aspergillus fumigatus remains low in the studied Spanish population.
  • Cryptic Aspergillus species are prevalent and exhibit a wider range of antifungal resistance, posing a significant clinical challenge.
  • Comprehensive surveillance and molecular characterization are crucial for understanding and combating the evolving landscape of antifungal resistance.
Keywords:
AspergillusFusariumMucoralesScedosporiumTR34/L98Hantifungal resistanceaspergillosisazole resistancecryptic speciescyp51A

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