Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Mar 18:1-10.
doi: 10.1007/s12281-023-00459-z. Online ahead of print.

Invasive Aspergillosis and the Impact of Azole-resistance

Davide Bosetti  1 , Dionysios Neofytos  1
Affiliations
Review

Invasive Aspergillosis and the Impact of Azole-resistance

Davide Bosetti et al. Curr Fungal Infect Rep. .

Abstract

Purpose of review: IA (invasive aspergillosis) caused by azole-resistant strains has been associated with higher clinical burden and mortality rates. We review the current epidemiology, diagnostic, and therapeutic strategies of this clinical entity, with a special focus on patients with hematologic malignancies.

Recent findings: There is an increase of azole resistance in Aspergillus spp. worldwide, probably due to environmental pressure and the increase of long-term azole prophylaxis and treatment in immunocompromised patients (e.g., in hematopoietic stem cell transplant recipients). The therapeutic approaches are challenging, due to multidrug-resistant strains, drug interactions, side effects, and patient-related conditions.

Summary: Rapid recognition of resistant Aspergillus spp. strains is fundamental to initiate an appropriate antifungal regimen, above all for allogeneic hematopoietic cell transplantation recipients. Clearly, more studies are needed in order to better understand the resistance mechanisms and optimize the diagnostic methods to identify Aspergillus spp. resistance to the existing antifungal agents/classes. More data on the susceptibility profile of Aspergillus spp. against the new classes of antifungal agents may allow for better treatment options and improved clinical outcomes in the coming years. In the meantime, continuous surveillance studies to monitor the prevalence of environmental and patient prevalence of azole resistance among Aspergillus spp. is absolutely crucial.

Keywords: Azole-resistance; Cryptic Aspergillus species; Invasive aspergillosis.

PubMed Disclaimer

Conflict of interest statement

Conflict of InterestThe authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Worldwide prevalence of azole resistant Aspergillus fumigatus (ARAF) clinical and environmental samples and isolates
See this image and copyright information in PMC

References

    1. Arastehfar A et al. Aspergillus fumigatus and aspergillosis: from basics to clinics. Stud Mycol. 2021;100:100115. - PMC - PubMed
    1. Houbraken J, et al. Classification of Aspergillus, Penicillium, Talaromyces and related genera (Eurotiales): an overview of families, genera, subgenera, sections, series and species. Stud Mycol. 2020;95:5–169. doi: 10.1016/j.simyco.2020.05.002. - DOI - PMC - PubMed
    1. Wiederhold NP, Locke JB, Daruwala P, Bartizal K. Rezafungin (CD101) demonstrates potent in vitro activity against Aspergillus, including azole-resistant Aspergillus fumigatus isolates and cryptic species. J Antimicrob Chemother. 2018;73:3063–3067. doi: 10.1093/jac/dky280. - DOI - PubMed
    1. dos Santos RAC et al. Genomic and phenotypic heterogeneity of clinical isolates of the human pathogens Aspergillus fumigatus, Aspergillus lentulus, and Aspergillus fumigatiaffinis. Front. Genet. Front Genet. 2020;11:459. - PMC - PubMed
    1. Lass-Flörl C. How to make a fast diagnosis in invasive aspergillosis. Med Mycol. 2019;57:S155–S160. doi: 10.1093/mmy/myy103. - DOI - PubMed

LinkOut - more resources