Paradoxal Trends in Azole-Resistant Aspergillus fumigatus in a National Multicenter Surveillance Program, the Netherlands, 2013-2018.
- Lestrade, P.P.A.
- Buil, J.B.
- Beek, M.T. van der
- Kuijper, E.J.
- Dijk, K van
- Kampinga, G.A.
- Rijnders, B.J.A.
- Vonk, A.G.
- Greeff, S.C. de
- Schoffelen, A.F.
- Dissel, J. van
- Meis, J.F.G.M.
- Melchers, W.J.G.
- Verweij, P.E.
DOIAbstract
We investigated the prevalence of azole resistance of Aspergillus fumigatus isolates in the Netherlands by screening clinical A. fumigatus isolates for azole resistance during 2013-2018. We analyzed azole-resistant isolates phenotypically by in vitro susceptibility testing and for the presence of resistance mutations in the Cyp51A gene. Over the 6-year period, 508 (11%) of 4,496 culture-positive patients harbored an azole-resistant isolate. Resistance frequency increased from 7.6% (95% CI 5.9%-9.8%) in 2013 (58/760 patients) to 14.7% (95% CI 12.3%-17.4%) in 2018 (112/764 patients) (p = 0.0001). TR(34)/L98H (69%) and TR(46)/Y121F/T289A (17%) accounted for 86% of Cyp51A mutations. However, the mean voriconazole MIC of TR(34)/L98H isolates dec...
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