Publication: Molecular Identification and Susceptibility Testing of Molds Isolated in a Prospective Surveillance of Triazole Resistance in Spain (FILPOP2 Study).
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Date
2018-08-27
Authors
Alastruey-Izquierdo, Ana
Alcazar-Fuoli, Laura
Rivero-Menéndez, Olga
Ayats, Josefina
Castro, Carmen
García-Rodríguez, Julio
Goterris-Bonet, Lidia
Ibáñez-Martínez, Elisa
Linares-Sicilia, María José
Martin-Gomez, M Teresa
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Abstract
Antifungal resistance is increasing by the emergence of intrinsically resistant species and by the development of secondary resistance in susceptible species. A previous study performed in Spain revealed levels of azole resistance in molds of between 10 and 12.7%, but secondary resistance in Aspergillus fumigatus was not detected. We used itraconazole (ITZ)-supplemented medium to select resistant strains. A total of 500 plates supplemented with 2 mg/liter of ITZ were sent to 10 Spanish tertiary hospitals, and molecular identification and antifungal susceptibility testing were performed. In addition, the cyp51A gene in those A. fumigatus strains showing azole resistance was sequenced. A total of 493 isolates were included in the study. Sixteen strains were isolated from patients with an infection classified as proven, 104 were isolated from patients with an infection classified as probable, and 373 were isolated from patients with an infection classified as colonization. Aspergillus was the most frequent genus isolated, at 80.3%, followed by Scedosporium-Lomentospora (7.9%), Penicillium-Talaromyces (4.5%), Fusarium (2.6%), and the order Mucorales (1%). Antifungal resistance was detected in Scedosporium-Lomentospora species, Fusarium, Talaromyces, and Mucorales Three strains of A. fumigatus sensu stricto were resistant to azoles; two of them harbored the TR34+L98H mechanism of resistance, and the other one had no mutations in cyp51A The level of azole resistance in A. fumigatus remains low, but cryptic species represent over 10% of the isolates and have a broader but overall higher range of antifungal resistance.
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MeSH Terms
Antifungal Agents
Aspergillus fumigatus
Cytochrome P-450 Enzyme System
Drug Resistance, Fungal
Fungal Proteins
Humans
Itraconazole
Microbial Sensitivity Tests
Prospective Studies
Spain
Triazoles
Aspergillus fumigatus
Cytochrome P-450 Enzyme System
Drug Resistance, Fungal
Fungal Proteins
Humans
Itraconazole
Microbial Sensitivity Tests
Prospective Studies
Spain
Triazoles
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CIE Terms
Keywords
Aspergillus, Fusarium, Mucorales, Scedosporium, TR34/L98H, antifungal resistance, aspergillosis, azole resistance, cryptic species, cyp51A