Azole-Resistance in Aspergillus terreus and Related Species: An Emerging Problem or a Rare Phenomenon?

Azole-Resistance in Aspergillus terreus and Related Species: An Emerging Problem or a Rare Phenomenon?

Author Zoran, Tamara Google Scholar
Sartori, Bettina Google Scholar
Sappl, Laura Google Scholar
Aigner, Maria Google Scholar
Sanchez-Reus, Ferran Google Scholar
Rezusta, Antonio Google Scholar
Chowdhary, Anuradha Google Scholar
Taj-Aldeen, Saad J. Google Scholar
Arendrup, Maiken C. Google Scholar
Oliveri, Salvatore Google Scholar
Kontoyiannis, Dimitrios P. Google Scholar
Alastruey-Izquierdo, Ana Google Scholar
Lagrou, Katrien Google Scholar
Lo Cascio, Giuliana Google Scholar
Meis, Jacques F. Google Scholar
Buzina, Walter Google Scholar
Farina, Claudio Google Scholar
Drogari-Apiranthitou, Miranda Google Scholar
Grancini, Anna Google Scholar
Tortorano, Anna M. Google Scholar
Willinger, Birgit Google Scholar
Hamprecht, Axel Google Scholar
Johnson, Elizabeth Google Scholar
Klingspor, Lena Google Scholar
Arsic-Arsenijevic, Valentina Google Scholar
Cornely, Oliver A. Google Scholar
Meletiadis, Joseph Google Scholar
Prammer, Wolfgang Google Scholar
Tullio, Vivian Google Scholar
Vehreschild, Jorg-Janne Google Scholar
Trovato, Laura Google Scholar
Lewis, Russell E. Google Scholar
Segal, Esther Google Scholar
Rath, Peter-Michael Google Scholar
Hamal, Petr Google Scholar
Rodriguez-Iglesias, Manuel Google Scholar
Roilides, Emmanuel Google Scholar
Arikan-Akdagli, Sevtap Google Scholar
Chakrabarti, Arunaloke Google Scholar
Colombo, Arnaldo Lopes Autor UNIFESP Google Scholar
Fernandez, Mariana S. Google Scholar
Teresa Martin-Gomez, M. Google Scholar
Badali, Hamid Google Scholar
Petrikkos, Georgios Google Scholar
Klimko, Nikolai Google Scholar
Heimann, Sebastian M. Google Scholar
Uzun, Omrum Google Scholar
Roudbary, Maryam Google Scholar
de la Fuente, Sonia Google Scholar
Houbraken, Jos Google Scholar
Risslegger, Brigitte Google Scholar
Lass-Floerl, Cornelia Google Scholar
Lackner, Michaela Google Scholar
Abstract Objectives: Invasive mold infections associated with Aspergillus species are a significant cause of mortality in immunocompromised patients. The most frequently occurring aetiological pathogens are members of the Aspergillus section Fumigati followed by members of the section Terrei. The frequency of Aspergillus terreus and related (cryptic) species in clinical specimens, as well as the percentage of azole-resistant strains remains to be studied. Methods : A global set (n = 498) of A. terreus and phenotypically related isolates was molecularly identified (beta-tubulin), tested for antifungal susceptibility against posaconazole, voriconazole, and itraconazole, and resistant phenotypes were correlated with point mutations in the cyp51A gene. Results : The majority of isolates was identified as A. terreus (86.8%), followed by A. citrinoterreus (8.4%), A. hortai (2.6%), A. alabamensis (1.6%), A. neoafricanus (0.2%), and A. floccosus (0.2%). One isolate failed to match a known Aspergillus sp., but was found most closely related to A. alabamensis. According to EUCAST clinical breakpoints azole resistance was detected in 5.4% of all tested isolates, 6.2% of A. terreus sensu stricto (s.s.) were posaconazole-resistant. Posaconazole resistance differed geographically and ranged from 0% in the Czech Republic, Greece, and Turkey to 13.7% in Germany. In contrast, azole resistance among cryptic species was rare 2 out of 66 isolates and was observed only in one A. citrinoterreus and one A. alabamensis isolate. The most affected amino acid position of the Cyp51A gene correlating with the posaconazole resistant phenotype was M217, which was found in the variation M217T and M217V. Conclusions : Aspergillus terreus was most prevalent, followed by A. citrinoterreus. Posaconazole was the most potent drug against A. terreus, but 5.4% of A. terreus sensu stricto showed resistance against this azole. In Austria, Germany, and the United Kingdom posaconazole-resistance in all A. terreus isolates was higher than 10%, resistance against voriconazole was rare and absent for itraconazole.
Keywords cryptic species
Aspergillus section Terrei
susceptibility profiles
Cyp51A alterations
xmlui.dri2xhtml.METS-1.0.item-coverage Lausanne
Language English
Sponsor ECMM
Christian Doppler Laboratory for invasive fungal infections
Date 2018
Published in Frontiers In Microbiology. Lausanne, v. 9, 2018.
ISSN 1664-302X (Sherpa/Romeo, impact factor)
Publisher Frontiers Media Sa
Extent -
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000428531200001

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