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Azole Resistance in Aspergillus Species Isolated from Clinical Samples: A Nine-Year Single-Center Study in Turkey
Zeynep Yazgan1, Reyhan Çalışkan2, Gökhan Aygün1,3
1Department of Medical Microbiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul 34320, Turkey.
Abstract:
Azole-resistant mycotic infections pose an escalating global health threat, with an estimated 6.5 million invasive fungal infections (IFIs) annually leading to 3.8 million deaths, 68% directly caused by IFIs. While azole antifungals are the cornerstone of treatment, emerging resistance, mainly due to gene mutations and efflux pump overexpression, is a major concern. This study, spanning 2015-2023, investigated azole resistance in clinical Aspergillus isolates in Turkey, a region lacking comprehensive surveillance. Of 200 causative isolates, A. fumigatus accounted for 45% and respiratory samples 57%. Overall azole resistance was 7%, rising to 11% for A. fumigatus. Findings highlight the persistent challenge of azole resistance, emphasizing the critical need for continued local and global surveillance to inform treatment guidelines and public health interventions. Despite limitations, including a single-center focus, this research provides crucial epidemiological insights into the evolving landscape of antifungal resistance in Turkey.
Insights
Azole resistance in fungal infections is a growing problem. This study found 7% azole resistance in Turkish Aspergillus isolates, highlighting the need for ongoing surveillance.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Azole antifungals are crucial for treating invasive fungal infections (IFIs).
- Emerging azole resistance, driven by genetic mutations and efflux pumps, threatens treatment efficacy.
- Global IFIs cause millions of deaths annually, underscoring the need for resistance monitoring.
Purpose of the Study:
- To investigate the prevalence of azole resistance in clinical Aspergillus isolates in Turkey from 2015-2023.
- To provide epidemiological data on antifungal resistance in a region with limited surveillance.
- To inform treatment guidelines and public health strategies regarding fungal infections.
Main Methods:
- Analysis of 200 clinical Aspergillus isolates collected between 2015 and 2023.
- Identification of species, with A. fumigatus being the most common (45%).
- Antifungal susceptibility testing to determine azole resistance rates.
Main Results:
- Overall azole resistance was observed in 7% of isolates.
- Aspergillus fumigatus isolates showed a higher resistance rate of 11%.
- Respiratory samples constituted the majority (57%) of positive cultures.
Conclusions:
- Azole resistance in Aspergillus is an ongoing challenge in Turkey.
- Continued local and global surveillance is essential for effective antifungal stewardship.
- This study offers vital insights into the evolving landscape of antifungal resistance.
