Azole-Resistance in Aspergillus terreus and Related Species: An Emerging Problem or a Rare Phenomenon?

Raquel Sabino was not included as an author in the published article. It was corrected a posteriori.Erratum in - Corrigendum: Azole-Resistance in Aspergillus terreus and Related Species: An Emerging Problem or a Rare Phenomenon? [Front Microbiol. 2018] Front Microbiol. 2019 Jan 14;9:3245. doi: 10.3389/fmicb.2018.03245. eCollection 2018.Disponível em: https://www.frontiersin.org/articles/10.3389/fmicb.2018.03245/fullFree PMC Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5882871/ | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340063/Objectives: Invasive mold infections associated with Aspergillus species are a significant cause of mortality in immunocompromised patients. The most frequently occurring aetiological pathogens are members of the Aspergillus section Fumigati followed by members of the section Terrei. The frequency of Aspergillus terreus and related (cryptic) species in clinical specimens, as well as the percentage of azole-resistant strains remains to be studied. Methods: A global set (n = 498) of A. terreus and phenotypically related isolates was molecularly identified (beta-tubulin), tested for antifungal susceptibility against posaconazole, voriconazole, and itraconazole, and resistant phenotypes were correlated with point mutations in the cyp51A gene. Results: The majority of isolates was identified as A. terreus (86.8%), followed by A. citrinoterreus (8.4%), A. hortai (2.6%), A. alabamensis (1.6%), A. neoafricanus (0.2%), and A. floccosus (0.2%). One isolate failed to match a known Aspergillus sp., but was found most closely related to A. alabamensis. According to EUCAST clinical breakpoints azole resistance was detected in 5.4% of all tested isolates, 6.2% of A. terreus sensu stricto (s.s.) were posaconazole-resistant. Posaconazole resistance differed geographically and ranged from 0% in the Czech Republic, Greece, and Turkey to 13.7% in Germany. In contrast, azole resistance among cryptic species was rare 2 out of 66 isolates and was observed only in one A. citrinoterreus and one A. alabamensis isolate. The most affected amino acid position of the Cyp51A gene correlating with the posaconazole resistant phenotype was M217, which was found in the variation M217T and M217V. Conclusions:Aspergillus terreus was most prevalent, followed by A. citrinoterreus. Posaconazole was the most potent drug against A. terreus, but 5.4% of A. terreus sensu stricto showed resistance against this azole. In Austria, Germany, and the United Kingdom posaconazole-resistance in all A. terreus isolates was higher than 10%, resistance against voriconazole was rare and absent for itraconazole.This work was supported by ECMM, ISHAM, and EFISG and in part by an unrestricted research grant through the Investigator Initiated Studies Programof Astellas, MSD, and Pfizer. This study was fundet by the Christian Doppler Laboratory for invasive fungal infections.info:eu-repo/semantics/publishedVersio

An evaluation of different steam disinfection protocols for cystic fibrosis nebulizers

Background: Contamination is a key element in cystic fibrosis. For this reason, nebulizer hygiene is an important, but complex and time-consuming task for cystic fibrosis patients. The aim of this study was to compare different steam disinfection and drying protocols. Methods: One hundred nebulizer parts were inoculated with cystic fibrosis-related bacteria in high concentrations (Burkholderia multivorans 3.9 × 1010/ml, Staphylococcus aureus 8.9 × 108/ml and Pseudomonas aeruginosa 2.1 × 109/ml). Tubes with Mycobacterium abscessus complex were additionally tested. Six steam disinfectors were compared. Different methods of drying were examined. Results: All tested bacteria were efficiently killed by the different steam disinfectors tested. The risk of contamination depended on the method of drying. Conclusions: Steam disinfection is a safe disinfection method. It is better to leave the nebulizers wet after steam disinfection than to manipulate them by active drying, which seems to be a source of recontamination

A prospective international Aspergillus terreus survey: An EFISG, ISHAM and ECMM joint study

Objectives: A prospective international multicentre surveillance study was conducted to investigate the prevalence and amphotericin B susceptibility of Aspergillus terreus species complex infections. Methods: A total of 370 cases from 21 countries were evaluated. Results: The overall prevalence of A. terreus species complex among the investigated patients with mould-positive cultures was 5.2% (370/7116). Amphotericin B MICs ranged from 0.125 to 32 mg/L, (median 8 mg/L). Conclusions: Aspergillus terreus species complex infections cause a wide spectrum of aspergillosis and the majority of cryptic species display high amphotericin B MICs.Fil: Risslegger, Brigitte. Universidad de Innsbruck; AustriaFil: Zoran, Tamara. Universidad de Innsbruck; AustriaFil: Lackner, Michaela. Universidad de Innsbruck; AustriaFil: Aigner, María. Universidad de Innsbruck; AustriaFil: Sanchez Reus, Ferrán. Hospital de la Santa Creu I Sant Pau; EspañaFil: Rezusta, Antonio. Universidad de Zaragoza; EspañaFil: Chowdhary, Anuradha. University of Delhi; IndiaFil: Alcacer Sanchez, Juan Manuel. Hospital de la Santa Creu I Sant Pau;Fil: Taj Aldeen, Saad Jaber. Hamad Medical Corporation; QatarFil: Arendrup, Maiken C.. Universidad de Copenhagen; DinamarcaFil: Oliveri, Salvatore. Università degli Studi di Catania; ItaliaFil: Kontoyiannis, Dimitrios P.. The University of Texas MD Anderson Cancer Center; Estados UnidosFil: Alastruey Izquierdo, Ana. Universidad Carlos III de Madrid. Instituto de Salud; EspañaFil: Lagrou, Katrien. Katholikie Universiteit Leuven; BélgicaFil: Lo Cascio, Giuliana. Azienda Ospedaliera Universitaria Integrata; ItaliaFil: Meis, Jacques F.. Canisius Wilhelmina Hospital; Países BajosFil: Buzina, Walter. Medical University of Graz; AustriaFil: Farina, Claudio. ASST Papa Giovanni XXIII. Microbiology Institute; ItaliaFil: Drogari Apiranthitou, Miranda. Universidad Nacional y Kapodistriaca de Atenas; GreciaFil: Grancini, Anna. Cà Granda Ospedale Maggiore Policlinico; ItaliaFil: Tortorano, Anna Maria. Università degli Studi di Milano; ItaliaFil: Willinger, Birgit. Universidad de Viena; AustriaFil: Hamprecht, Axel. Universitat Zu Köln; AlemaniaFil: Johnson, Elizabeth. Public Health England. Mycology Reference Laboratory; Reino UnidoFil: Klingspor, Lena. Karolinska Huddinge Hospital; SueciaFil: Arsic Arsenijevic, Valentina. University of Belgrade; SerbiaFil: Cornely, Oliver A.. Universitat Zu Köln; AlemaniaFil: Meletiadis, Joseph. Universidad Nacional y Kapodistriaca de Atenas; GreciaFil: Prammer, Wolfgang. Klinikum Wels-Grieskirchen; AustriaFil: Tullio, Vivian. Università di Torino; ItaliaFil: Vehreschild, Jörg Janne. Universitat Bonn; Alemania. Universitat Zu Köln; AlemaniaFil: Trovato, Laura. Università degli Studi di Catania; ItaliaFil: Lewis, Russell E.. Universidad de Bologna; ItaliaFil: Segal, Esther. Tel Aviv University; IsraelFil: Rath, Peter Michael. Universitat Essen; AlemaniaFil: Hamal, Petr. Universtity Hospital Olomouc; República Checa. Palacky University Olomouc; República ChecaFil: Rodríguez Iglesias, Manuel. Universidad de Cádiz; EspañaFil: Roilides, Emmanuel. Aristotle University School of Health Sciences; GreciaFil: Arikan Akdagli, Sevtap. Hacettepe University; TurquíaFil: Chakrabarti, Arunaloke. Postgraduate Institute of Medical Education and Research; IndiaFil: Colombo, Arnaldo L.. Universidade Federal de Sao Paulo; BrasilFil: Fernández, Mariana Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Martin Gomez, M. Teresa. Vall d’Hebron University Hospital; EspañaFil: Badali, Hamid. Mazandaran University of Medical Sciences; IránFil: Petrikkos, Georgios. European University Cyprus; ChipreFil: Klimko, Nikolai. North Western State Medical University; RusiaFil: Heimann, Sebastian M.. Universitat Zu Köln; AlemaniaFil: Houbraken, Jos. Fungal Biodiversity Centre; Países BajosFil: Uzun, Omrum. Hacettepe University Medical School; TurquíaFil: Edlinger, Michael. Universidad de Innsbruck; AustriaFil: de la Fuente, Sonia. Hospital Ernest Lluch Martin; EspañaFil: Lass Flörl, Cornelia. Universidad de Innsbruck; Austri

DataSheet1.pdf

<p>Objectives: Invasive mold infections associated with Aspergillus species are a significant cause of mortality in immunocompromised patients. The most frequently occurring aetiological pathogens are members of the Aspergillus section Fumigati followed by members of the section Terrei. The frequency of Aspergillus terreus and related (cryptic) species in clinical specimens, as well as the percentage of azole-resistant strains remains to be studied.</p><p>Methods: A global set (n = 498) of A. terreus and phenotypically related isolates was molecularly identified (beta-tubulin), tested for antifungal susceptibility against posaconazole, voriconazole, and itraconazole, and resistant phenotypes were correlated with point mutations in the cyp51A gene.</p><p>Results: The majority of isolates was identified as A. terreus (86.8%), followed by A. citrinoterreus (8.4%), A. hortai (2.6%), A. alabamensis (1.6%), A. neoafricanus (0.2%), and A. floccosus (0.2%). One isolate failed to match a known Aspergillus sp., but was found most closely related to A. alabamensis. According to EUCAST clinical breakpoints azole resistance was detected in 5.4% of all tested isolates, 6.2% of A. terreus sensu stricto (s.s.) were posaconazole-resistant. Posaconazole resistance differed geographically and ranged from 0% in the Czech Republic, Greece, and Turkey to 13.7% in Germany. In contrast, azole resistance among cryptic species was rare 2 out of 66 isolates and was observed only in one A. citrinoterreus and one A. alabamensis isolate. The most affected amino acid position of the Cyp51A gene correlating with the posaconazole resistant phenotype was M217, which was found in the variation M217T and M217V.</p><p>Conclusions:Aspergillus terreus was most prevalent, followed by A. citrinoterreus. Posaconazole was the most potent drug against A. terreus, but 5.4% of A. terreus sensu stricto showed resistance against this azole. In Austria, Germany, and the United Kingdom posaconazole-resistance in all A. terreus isolates was higher than 10%, resistance against voriconazole was rare and absent for itraconazole.</p