Determination of the prevalence of triazole resistance in environmental Aspergillus fumigatus strains isolated in South Wales, UK

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Abstract

Background/Objectives: Azole resistance in Aspergillus fumigatus associated with the TR34/L98H mutations in the cyp51A gene have been increasingly reported. Determining the environmental resistance rate has been deemed important when considering front-line therapy for invasive aspergillosis. The aim of the study was to determine prevalence of azole resistance in environmental A. fumigatus isolates across South Wales. Methods: Over 5 months in 2015, 513 A. fumigatus isolates were cultured from 671 soil and 44 air samples and were screened for azole resistance using VIPcheck™ agar plates containing itraconazole, voriconazole and posaconazole. Resistance was confirmed by the CLSI M38-A2 methodology. The mechanism of resistance was investigated using the PathoNostics AsperGenius® Assay. Results: Screening by VIPcheck™ plate identified azole-resistance in 30 isolates, most of which (28/30) harbored the TR34/L98H mutation, generating a prevalence of 6.0%. Twenty-five isolates had a MIC of ≥ 2 mg/L with itraconazole, 23 isolates had a MIC of ≥ 2 mg/L with voriconazole and seven isolates had a MIC ≥ 0.25 mg/L with posaconazole. All isolates deemed resistant by VIPcheck™ plates were resistant to at least one azole by reference methodology. Conclusions: There is significant environmental azole resistance (6%) in South Wales, in close proximity to patients susceptible to aspergillosis. Given this environmental reservoir, azole resistance should be routinely screened for in clinical practice and environmental monitoring continued.

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Tsitsopoulou, A., Posso, R., Vale, L., Bebb, S., Johnson, E., & White, P. L. (2018). Determination of the prevalence of triazole resistance in environmental Aspergillus fumigatus strains isolated in South Wales, UK. Frontiers in Microbiology, 9(JUN). https://doi.org/10.3389/fmicb.2018.01395

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