Tamara Zoran, Bettina Sartori, Laura Sappl, Maria Aigner, Ferran Sánchez-Reus, Antonio Rezusta, Anuradha Chowdhary, Saad J. Taj-Aldeen, Maiken C. Arendrup, Salvatore Oliveri, Dimitrios P. Kontoyiannis, Ana Alastruey-Izquierdo, Katrien Lagrou, Giuliana Lo Cascio, Jacques F. Meis, Walter Buzina, Claudio Farina, Miranda Drogari-Apiranthitou, Anna Grancini, Anna M. Tortorano, Birgit Willinger, Axel Hamprecht, Elizabeth Johnson, Lena Klingspor, Valentina Arsic-Arsenijevic, Oliver A. Cornely, Joseph Meletiadis, Wolfgang Prammer, Vivian Tullio, Jörg-Janne Vehreschild, Laura Trovato, Russell E. Lewis, Esther Segal, Peter-Michael Rath, Petr Hamal, Manuel Rodriguez-Iglesias, Emmanuel Roilides, Sevtap Arikan-Akdagli, Arunaloke Chakrabarti, Arnaldo L. Colombo, Mariana S. Fernández, M. Teresa Martin-Gomez, Hamid Badali, Georgios Petrikkos, Nikolai Klimko, Sebastian M. Heimann, Omrum Uzun, Maryam Roudbary, Sonia de la Fuente, Jos Houbraken, Brigitte Risslegger, Cornelia Lass-Flörl, Michaela Lackner, Zoran T, Sartori B, Sappl L, Aigner M, Sánchez-Reus F, Rezusta A, Chowdhary A, Taj-Aldeen SJ, Arendrup MC, Oliveri S7, Kontoyiannis DP, Alastruey-Izquierdo A, Lagrou K, Cascio GL, Meis JF, Buzina W, Farina C, Drogari-Apiranthitou M, Grancini A, Tortorano AM, Willinger B, Hamprecht A, Johnson E, Klingspor L, Arsic-Arsenijevic V, Cornely OA, Meletiadis J, Prammer W, Tullio V, Vehreschild JJ, Trovato L, Lewis RE, Segal E, Rath PM, Hamal P, Rodriguez-Iglesias M, Roilides E, Arikan-Akdagli S, Chakrabarti A, Colombo AL, Fernández MS, Martin-Gomez MT, Badali H, Petrikkos G, Klimko N, Heimann SM, Uzun O, Roudbary M, de la Fuente S, Houbraken J, Risslegger, Lass-Flörl C, Lackner M., Bioquímica y Biología Molecular, Microbiología, Medicina Preventiva, Salud Pública, and Westerdijk Fungal Biodiversity Institute
ECMM ISHAM EFISG Astellas MSD Pfizer Christian Doppler Laboratory for invasive fungal infections 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. Med Univ Innsbruck, Div Hyg & Med Microbiol, Innsbruck, Austria Hosp Santa Creu & Sant Pau, Serv Microbiol, Barcelona, Spain Univ Zaragoza, Hosp Univ Miguel Servet, IIS Aragon, Microbiol, Zaragoza, Spain Univ Delhi, Vallabhbhai Patel Chest Inst, Dept Med Mycol, New Delhi, India Hamad Med Corp, Dept Lab Med & Pathol, Microbiol Div, Doha, Qatar Univ Copenhagen, Rigshosp, Dept Clin Microbiol, Unit Mycol,Statens Serum Inst, Copenhagen, Denmark Univ Catania, Dept Biomed & Biotechnol Sci, Catania, Italy Univ Texas MD Anderson Canc Ctr, Houston, TX USA Inst Salud Carlos III, Natl Ctr Microbiol, Madrid, Spain Katholieke Univ Leuven, Dept Microbiol & Immunol, Leuven, Belgium Univ Integrata, Azienda Osped, Dipartimento Patol Diagnost, Unita Operat Complessa Microbiol & Virol, Verona, Italy Canisius Wilhelmina Hosp, Dept Med Microbiol & Infect Dis, Nijmegen, Netherlands Med Univ Graz, Inst Hyg Microbiol & Environm Med, Graz, Austria ASST Papa Giovanni XXIII, Microbiol Inst, Bergamo, Italy Univ Athens, ATTIKON Univ Hosp, Dept Internal Med 4, Infect Dis Res Lab, Athens, Greece Ca Granda Osped Maggiore Policlin, IRCCS Fdn, Lab Cent Analisi Chim Clin & Microbiol, Milan, Italy Univ Milan, Dept Biomed Sci Hlth, Milan, Italy Med Univ Vienna, Dept Lab Med, Div Clin Microbiol, Vienna, Austria Univ Cologne, Inst Med Microbiol Immunol & Hyg, Cologne, Germany Publ Hlth England, Mycol Reference Lab, Bristol, Avon, England Karolinska Univ Hosp, Karolinska Inst, Dept Lab Med, Stockholm, Sweden Univ Belgrade, Inst Microbiol & Immunol, Fac Med, Natl Reference Med Mycol Lab, Belgrade, Serbia Univ Cologne, German Ctr Infect Res, Ctr Integrated Oncol CIO Koln Bonn,Clin Trials Ct, Dept Internal Med,Cologne Excellence Cluster Cell, Cologne, Germany ATTIKON Univ, Hosp Athens, Natl Kapodistrian Univ Athens, Clin Microbiol Lab, Athens, Greece Klinikum Wels Grieskirchen, Dept Hyg & Med Microbiol, Wels, Austria Div Microbiol, Dept Publ Hlth & Pediat, Turin, Italy Univ Hosp Cologne, Dept Internal Med, Cologne, Germany Partner Site Bonn Cologne, German Ctr Infect Res, Cologne, Germany Biometec Univ Catania, AOU Policlin Vittorio Emanuele Catania, Catania, Italy Univ Bologna, S Orsola Malpighi, Dept Med & Surg Sci, Infect Dis Unit, Bologna, Italy Tel Aviv Univ, Sackler Sch Med, Dept Clin Microbiol & Immunol, Tel Aviv, Israel Univ Duisburg Essen, Univ Hosp Essen, Inst Med Microbiol, Essen, Germany Palacky Univ Olomouc, Fac Med & Dent, Dept Microbiol, Olomouc, Czech Republic Univ Hosp Olomouc, Olomouc, Czech Republic Univ Cadiz, Puerta Mar Univ Hosp, Clin Microbiol, Cadiz, Spain Hippokrateion Hosp, Aristotle Univ Sch Hlth Sci, Fac Med, Infect Dis Unit,Dept Pediat 3, Thessaloniki, Greece Hacettepe Univ Med Sch, Dept Med Microbiol, Ankara, Turkey Postgrad Inst Med Educ & Res, Dept Medial Microbiol, Div Mycol, Chandigarh, India Univ Fed Sao Paulo, Escola Paulista Med, Sao Paulo, Brazil Univ Nacl Nordeste, CONICET, Inst Medicina Reg, Dept Micol, Resistencia, Argentina Vall Hebron Univ Hosp, Dept Microbiol, Div Clin Mycol, Barcelona, Spain Mazandaran Univ Med Sci, Dept Med Mycol & Parasitol, Invas Fungi Res Ctr, Sari, Iran European Univ Cyprus, Sch Med, Nicosia, Cyprus North Western State Med Univ, Dept Clin Mycol Allergy & Immunol, St Petersburg, Russia Univ Hosp Cologne, Dept Internal Med, Cologne, Germany Hacettepe Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Ankara, Turkey Iran Univ Med Sci, Sch Med, Dept Med Mycol & Parasitol, Tehran, Iran Hosp Ernest Lluch Martin, Dept Dermatol, Zaragoza, Spain Westerdijk Fungal Biodivers Inst, Dept Appl & Ind Mycol, Utrecht, Netherlands Univ Fed Sao Paulo, Escola Paulista Med, Sao Paulo, Brazil Web of Science