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

• Published in: Environmental microbiology Vol. 20; no. 1; pp. 270 - 280
• Main Authors: Wang, Hsuan‐Chen, Huang, Jui‐Chang, Lin, Yong‐Hong, Chen, Yu‐Hsin, Hsieh, Ming‐I, Choi, Pui‐Ching, Lo, Hsiu‐Jung, Liu, Wei‐Lun, Hsu, Ching‐Shan, Shih, Hsin‐I, Wu, Chi‐Jung, Chen, Yee‐Chun
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-01-2018
• Subjects: Agricultural management; Air Microbiology; Antifungal Agents - therapeutic use; Aspergillosis - drug therapy; Aspergillosis - epidemiology; Aspergillosis - microbiology; Aspergillus fumigatus; Aspergillus fumigatus - drug effects; Aspergillus fumigatus - genetics; Aspergillus fumigatus - isolation & purification; Azoles; Azoles - therapeutic use; Clinical isolates; Cytochrome P-450 Enzyme System - genetics; Drug Resistance, Fungal - genetics; Efflux; Fungal Proteins - genetics; Fungi; Fungicides; Genes; Genotype; Genotypes; Genotyping; Growth rate; Health risks; Heterocyclic compounds; Humans; Itraconazole; Itraconazole - therapeutic use; Microbial Sensitivity Tests; Microsatellite Repeats - genetics; Microsatellites; Municipalities; Mutation; Mutation - genetics; Pesticides; Posaconazole; Prevalence; Soil; Soil Microbiology; Surveillance; Taiwan - epidemiology; Triazoles - therapeutic use; Voriconazole; Voriconazole - therapeutic use; Yard waste; Taiwan
• ISSN: 1462-2912; 1462-2920
• DOI: 10.1111/1462-2920.13988

Summary
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 2760 air and soil samples screened from 2014 to 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 harboured 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.