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Azole resistance survey on clinical Aspergillus fumigatus isolates in Spain

Pilar Escribano1, Belén Rodríguez-Sánchez2, Judith Díaz-García1

  • 1Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|October 3, 2020
PubMed
Abstract

Insights

In Spain, 6.6% of patients carried azole-resistant Aspergillus fumigatus. The TR34-L98H substitution was the most common resistance mechanism found in Aspergillus fumigatus sensu stricto.

Area of Science:

  • Medical Mycology
  • Antimicrobial Resistance
  • Clinical Microbiology

Background:

  • Azole antifungals are crucial for treating invasive fungal infections.
  • Emergence of azole resistance in Aspergillus fumigatus poses a significant public health threat.
  • Monitoring resistance patterns is essential for effective patient management.

Purpose of the Study:

  • To determine the prevalence of azole resistance in Aspergillus fumigatus clinical isolates across Spain.
  • To identify the genetic mechanisms underlying azole resistance.
  • To assess the proportion of patients infected with azole-resistant strains.

Main Methods:

  • Collection of Aspergillus fumigatus sensu lato isolates from 30 Spanish hospitals between February and May 2019.
  • Susceptibility testing to azoles using EUCAST methodology.
  • Molecular identification of isolates and sequencing of the cyp51A gene in resistant strains.

Main Results:

  • Out of 847 isolates, 7.4% exhibited resistance to at least one azole.
  • Azole resistance was significantly higher in cryptic species (95%) compared to Aspergillus fumigatus sensu stricto (5.5%).
  • The TR34-L98H substitution in the cyp51A gene was the predominant resistance mechanism (24/63 isolates).

Conclusions:

  • 6.6% of patients in Spain were found to carry azole-resistant Aspergillus fumigatus sensu lato.
  • TR34-L98H represents the primary genetic driver of azole resistance in Aspergillus fumigatus sensu stricto.
  • While common, the widespread geographical distribution of this specific resistance mutation requires further investigation.
Keywords:
Aspergillus fumigatusAzoleIsavuconazoleResistanceVoriconazole

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