Related Experiment Video
Updated: Sep 19, 2025
Isolation of Culturable Yeasts and Molds from Soils to Investigate Fungal Population Structure
Published on: May 27, 2022
Meta-analysis of antifungal resistance patterns of Aspergillus species in Iran
Ibrahim Bahrami Mianrood1, Farid Javandoust Gharebagh2, Sadegh Khodavaisy3
1Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Background And Objectives:
Aspergillus infection has several manifestations, ranging from noninvasive aspergillosis to invasive pulmonary and cerebral aspergillosis. Prophylaxis and treatment regimens for aspergillosis rely on triazoles, echinocandins, and polyenes, with specific efficacies, complications, and resistance patterns. Drug selection presents challenges, including differences in resistance rates, drug interactions, and concerns about side effects with long-term use. Aspergillus resistance to antifungal agents is an international concern and has shown an increasing trend. Each region worldwide has a resistance pattern affecting prevention and treatment regimens.
Methods:
This meta-analysis started with a systematic search through PubMed, Scopus, Web of Science, Scientific Information Database (SID) and MagIran based on a combination of these keywords with "AND/OR" operators: Aspergillus/Aspergilli, resistance/resistant, susceptibility/susceptible, drug, antimicrobial(s), antifungal(s) and Iran. Search results are reported on the basis of the Preferred Reporting Items for Systematic and Meta-analyses (PRISMA).
Results:
The pooled resistance rates of Aspergillus fumigatus were 6.97 % for amphotericin B, 1.40 % for caspofungin, 17.61 % for itraconazole, 4.56 % for posaconazole, and 14.68 % for voriconazole. The percentage of resistance in Aspergillus flavus was 13.16 % for amphotericin B, 13.09 % for caspofungin, 10.19 % for itraconazole, 1.23 % for posaconazole, and 0.58 % for voriconazole.
Conclusion:
Our findings highlight the need for antifungal resistance surveillance in Iran. Treatment decisions should consider resistance patterns, host factors, and drug pharmacokinetics. We recommend establishing antifungal stewardship programs to develop evidence-based guidelines. Based on our findings, we suggest posaconazole or voriconazole for A. fumigatus and A. flavus, amphotericin B as alternative therapy, and caspofungin as salvage therapy.
Insights
Antifungal resistance in Aspergillus species is increasing globally. In Iran, resistance rates vary, with posaconazole and voriconazole recommended for treatment, alongside surveillance programs.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pharmacology
Background:
- Aspergillus infections present diverse clinical manifestations, from noninvasive to invasive forms.
- Current antifungal prophylaxis and treatment primarily utilize triazoles, echinocandins, and polyenes.
- Challenges in drug selection include evolving resistance patterns, drug interactions, and long-term side effect concerns.
Purpose of the Study:
- To systematically review and meta-analyze antifungal resistance patterns of Aspergillus species in Iran.
- To inform clinical decision-making and guide the development of effective antifungal stewardship programs.
Main Methods:
- A systematic literature search was conducted across PubMed, Scopus, Web of Science, SID, and MagIran.
- Keywords included 'Aspergillus/Aspergilli', 'resistance/resistant', 'susceptibility/susceptible', 'drug', 'antimicrobial(s)', 'antifungal(s)', and 'Iran'.
- The meta-analysis adhered to the Preferred Reporting Items for Systematic and Meta-analyses (PRISMA) guidelines.
Main Results:
- Pooled resistance rates for Aspergillus fumigatus: Amphotericin B (6.97%), Caspofungin (1.40%), Itraconazole (17.61%), Posaconazole (4.56%), Voriconazole (14.68%).
- Pooled resistance rates for Aspergillus flavus: Amphotericin B (13.16%), Caspofungin (13.09%), Itraconazole (10.19%), Posaconazole (1.23%), Voriconazole (0.58%).
- Significant variations in resistance rates were observed across different antifungal agents and Aspergillus species.
Conclusions:
- Antifungal resistance surveillance in Iran is crucial due to observed resistance trends.
- Treatment strategies should integrate resistance data, host factors, and drug pharmacokinetics.
- Posaconazole or voriconazole are suggested for A. fumigatus and A. flavus, with amphotericin B as an alternative and caspofungin as salvage therapy.
Related Concept Videos
01:28Fungal Phylum Ascomycota
01:28Antimicrobial Effectiveness