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Aspergillus Species Causing Invasive Fungal Disease in Queensland, Australia

Adam G Stewart1,2,3, Burcu Isler4,5, Peter Simos5

  • 1Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia. Adam.Stewart@health.qld.gov.au.

Mycopathologia
|April 17, 2023
PubMed
Abstract

Insights

Antifungal drug resistance in Aspergillus species is rising, particularly in cryptic species. This study highlights the need for ongoing surveillance of Aspergillus antifungal susceptibility patterns to guide clinical care.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Aspergillus species cause invasive fungal disease, especially in immunocompromised individuals.
  • Rising antifungal drug resistance in Aspergillus spp., particularly cryptic species, necessitates understanding local susceptibility patterns.
  • Optimal clinical care depends on knowledge of regional antifungal susceptibility.

Purpose of the Study:

  • To investigate antifungal susceptibility patterns of Aspergillus species in Queensland, Australia.
  • To identify trends in antifungal resistance over time.
  • To assess the prevalence of cryptic Aspergillus species and their resistance profiles.

Main Methods:

  • Analysis of 236 Aspergillus spp. clinical isolates from Pathology Queensland (2000-2021).
  • Species identification using morphology and internal transcribed spacer (ITS) sequencing.
  • Antifungal susceptibility testing (CLSI M38-A3) for Amphotericin B, voriconazole, posaconazole, isavuconazole, micafungin, caspofungin, and anidulafungin.

Main Results:

  • Aspergillus section Fumigati (n=119) was the most frequent species.
  • Low minimum inhibitory concentration (MIC) values were observed for echinocandins.
  • Cryptic species showed high voriconazole MICs (MIC50/90 = 2/8 mg/L), with an increasing incidence from 2017-2021.

Conclusions:

  • The rise in antifungal resistance among Aspergillus spp. requires continued local and global investigation.
  • Active surveillance of Aspergillus emergence and antifungal susceptibility is crucial.
  • Findings will inform clinicians and update treatment guidelines for invasive aspergillosis.
Keywords:
Antifungal susceptibility testingAspergillus speciesAzole resistance

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