Azole Resistance in Aspergillus Species Isolated from Clinical Samples: A Nine-Year Single-Center Study in Turkey (2015–2023)

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.