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Azole resistant Aspergillus fumigatus: What you need to know

Shawn R Lockhart1, Karlyn Beer1, Mitsuru Toda1

  • 1Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA.

Clinical Microbiology Newsletter
|April 3, 2025
PubMed

Insights

Azole resistance in Aspergillus fumigatus is increasing due to specific gene mutations. Antifungal susceptibility testing is crucial for identifying this resistance in clinical settings.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Aspergillosis, a common fungal infection, is primarily caused by Aspergillus fumigatus.
  • Increasing reports indicate A. fumigatus isolates resistant to azole antifungals.
  • This resistance poses a significant challenge in treating fungal infections.

Purpose of the Study:

  • To review the causes and implications of azole-resistant A. fumigatus.
  • To discuss the role of antifungal susceptibility testing in identifying azole resistance.

Main Methods:

  • Literature review of studies on azole resistance in A. fumigatus.
  • Analysis of common resistance mechanisms, including CYP51A mutations (TR34/L98H, TR46/Y121F/T289A).

Main Results:

  • Environmentally acquired mutations in the CYP51A gene are the predominant cause of azole resistance.
  • Limited antifungal susceptibility testing capacity in the US hinders understanding of resistance extent.
  • Azole resistance has significant clinical implications for aspergillosis treatment.

Conclusions:

  • Azole-resistant A. fumigatus is an emerging threat.
  • Antifungal susceptibility testing is essential for clinical management and surveillance.
  • Further efforts are needed to expand testing capacity and address resistance.

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