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

Summary

This study examined azole antifungal resistance in fungal infections from a Turkish hospital over nine years. Researchers tested 200 Aspergillus fungal isolates and found that 7% showed resistance to azole medications, with 11% of Aspergillus fumigatus showing resistance. The findings highlight the ongoing challenge of drug-resistant fungal infections and the importance of monitoring resistance patterns to improve treatment decisions for serious fungal infections.

Background

Azole-resistant mycotic infections pose an escalating global health threat, with an estimated 6.5 million invasive fungal infections annually leading to 3.8 million deaths. Azole antifungals are the cornerstone of aspergillosis treatment, but emerging resistance due to gene mutations and efflux pump overexpression is a major concern. Turkey lacks comprehensive surveillance data on azole resistance in clinical Aspergillus isolates.

Objective

To investigate the prevalence of azole resistance in clinical Aspergillus isolates isolated in Turkey between 2015 and 2023. The study aimed to provide crucial epidemiological insights into the evolving landscape of antifungal resistance in a region with limited surveillance data.

Results

Of 200 causative isolates, A. fumigatus accounted for 45% and respiratory samples represented 57% of sources. Overall azole resistance was 7%, rising to 11% for A. fumigatus. Resistance rates did not show significant increase over the nine-year study period, with resistant isolates including pan-azole resistant strains and various single or dual azole resistances.

Conclusion

This nine-year study reveals persistent and significant azole resistance in clinical Aspergillus isolates in Turkey, particularly in A. fumigatus. The findings emphasize the critical need for continued local and global surveillance, routine susceptibility testing, antifungal stewardship, and coordinated efforts between health authorities and agricultural sectors to inform treatment guidelines and public health interventions.
  • Published in:Journal of Fungi,
  • Study Type:Retrospective Observational Study,
  • Source: PMID: 41003205, DOI: 10.3390/jof11090659
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