5 years ago

Prevalence, mechanisms, and genetic relatedness of the human pathogenic fungus Aspergillus fumigatus exhibiting resistance to medical azoles in the environment of Taiwan

Hsiu-Jung Lo, Hsin-I Shih, Wei-Lun Liu, Hsuan-Chen Wang, Yu-Hsin Chen, Yee-Chun Chen, Chi-Jung Wu, Yong-Hong Lin, Ming-I Hsieh, Jui-Chang Huang, Ching-Shan Hsu, Pui-Ching Choi
Emerging azole resistance in Aspergillus fumigatus poses a serious threat to human health. This nationwide surveillance study investigated the prevalence and molecular characteristics of azole-resistant A. fumigatus environmental isolates in Taiwan, an island country with increasing use of azole fungicides. Of the 2,760 air and soil samples screened from 2014-2016, 451 A. fumigatus isolates were recovered from 266 samples, and 34 isolates from 29 samples displayed resistance to medical azoles (itraconazole, voriconazole, or posaconazole). The resistance prevalence was 10.9% and 7.5% in A. fumigatus-positive samples and isolates, respectively. Most (29, 85.3%) azole-resistant isolates harbored TR34/L98H mutations, which were widely distributed, clustered genetically with clinical isolates, and had growth rates that were similar to those of the wild-type isolates. Microsatellite genotyping revealed both the global spread of the TR34/L98H isolates and the occurrence of TR34/L98H/S297T/F495I isolates belonging to local microsatellite genotypes. AfuMDR3 and atrF, two efflux transporter genes, were constitutively upregulated in two individual resistant isolates without cyp51A mutations, highlighting their potential roles in azole resistance. These results emphasize the need for periodic environmental surveillance at the molecular level in regions in which azole fungicides are applied, and agricultural fungicide management strategies that generate less selective pressure should be investigated. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/1462-2920.13988

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