Antifungal Resistance in Clinical Isolates of Aspergillus spp.: When Local Epidemiology Breaks the Norm

Romero, Mercedes; Messina, Fernando; Marín, Emmanuel; Arechavala, Alicia; Depardo, Roxana; Walker, Laura; Negroni, Ricardo; Santiso, Gabriela

doi:10.3390/jof5020041

Cited by 27 publications

(23 citation statements)

References 28 publications

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“…Widespread use of antifungals has altered the epidemiological landscape of IFIs, where fungal species showing resistance to one and/or multiple classes of antifungals are increasingly identified in clinical settings and associated with therapeutic failure [ 16 , 17 , 18 , 19 ]. The most notable examples are the worldwide emergence of triazole-resistant Aspergillus fumigatus [ 16 , 19 , 20 ], Candida tropicalis , Candida parapsilosis [ 18 ], and multidrug-resistant (MDR) Candida auris [ 21 ] and the increasing prevalence of MDR Candida glabrata , especially in the U.S. [ 22 ]. Beyond Candida and Aspergillus , a growing body of evidence for Pneumocystis indicates that resistance develops in patients receiving sulfa prophylaxis and trimethoprim–sulfamethoxazole [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Drug-Resistant Fungi: An Emerging Challenge Threatening Our Limited Antifungal Armamentarium

et al. 2020

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The high clinical mortality and economic burden posed by invasive fungal infections (IFIs), along with significant agricultural crop loss caused by various fungal species, has resulted in the widespread use of antifungal agents. Selective drug pressure, fungal attributes, and host- and drug-related factors have counteracted the efficacy of the limited systemic antifungal drugs and changed the epidemiological landscape of IFIs. Species belonging to Candida, Aspergillus, Cryptococcus, and Pneumocystis are among the fungal pathogens showing notable rates of antifungal resistance. Drug-resistant fungi from the environment are increasingly identified in clinical settings. Furthermore, we have a limited understanding of drug class-specific resistance mechanisms in emerging Candida species. The establishment of antifungal stewardship programs in both clinical and agricultural fields and the inclusion of species identification, antifungal susceptibility testing, and therapeutic drug monitoring practices in the clinic can minimize the emergence of drug-resistant fungi. New antifungal drugs featuring promising therapeutic profiles have great promise to treat drug-resistant fungi in the clinical setting. Mitigating antifungal tolerance, a prelude to the emergence of resistance, also requires the development of effective and fungal-specific adjuvants to be used in combination with systemic antifungals.

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Section: Introductionmentioning

confidence: 99%

Drug-Resistant Fungi: An Emerging Challenge Threatening Our Limited Antifungal Armamentarium

et al. 2020

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“…It is ubiquitous in the environment with small spores, which enhance its penetration and colonization to airways, especially in patients with compromised lung mucosal defense. This allows its spread into other organs, causing hematogenous fungal diseases [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Suppression effect of thyme and carvacrol nano-emulsions on Aspergillus fumigatus isolated from patients in the intensive care unit of Assiut University Hospital, Egypt

Hassanien

Elsherif²,

Hamed

et al. 2021

Int J One Health

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Background and Aim: Aspergillus fumigatus is a zoonotic fungus that causes several diseases in humans ranging from allergic reaction to fatal disseminated invasive infection, especially in immunocompromised patients. This study aimed to investigate the incidence of invasive A. fumigatus in patients admitted to the intensive care unit (ICU) of Assiut University Hospital, highlight the factors associated with their infection, and determine the antifungal effect of thyme nano-emulsion (TNE) and carvacrol nano-emulsion (CNE) on isolated A. fumigatus strains. Materials and Methods: Mycological culture method and scanning electron microscopy (SEM) were used in the identification of A. fumigatus in 630 blood samples collected from 210 patients. TNE and CNE at five concentrations (1%, 2%, 4%, 6%, and 8%) and average sizes of 90.3 and 75.6 nm, respectively, were characterized by transmission electron microscopy. Their effect on A. fumigatus isolate growth was evaluated by the well-diffusion method and SEM, which was used for the detection of the degenerative effect of A. fumigatus ultrastructure. Results: A. fumigatus was detected in 54 of 210 (25.7%) patients in the ICU. Advanced age and chronic diseases were considered important risk factors for invasive aspergillosis, especially in patients with more than 1 clinical disease. TNE and CNE showed an inhibitory effect on A. fumigatus isolates, which significantly increased with high concentrations. The respective values for TNE at concentrations of 6% and 8% were 6±0.41 mm and 15±0.67 mm. CNE completely inhibited A. fumigatus growth at concentrations of 4%, 6%, and 8%, while mean inhibition zones of 22±0.68 mm and 30±0.32 mm appeared at concentrations of 1% and 2%. SEM demonstrated degenerative changes in A. fumigatus structure. Conclusion: TNE and CNE can be used in bioactive treatments against A. fumigatus, and additional studies are required to determine the safe and effective doses and best method for application in human and veterinary medicine.

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“…This situation might become a potential source of nosocomial Aspergillus transmission because the possibility of the dust during hospital reconstruction might carry transient Aspergillus spores [33]. Conducting antifungal susceptibility profiling of Aspergillus from the environment is also indispensable if we would be able to anticipate the emergence of resistant species that could complicate IPA management [34].…”

Section: Discussionmentioning

confidence: 99%

Molecular typing and antifungal susceptibility study of Aspergillus spp. in intensive care unit (ICU) patients in Indonesia

Rozaliyani

Sedono

Sjam

et al. 2021

J Infect Dev Ctries

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Introduction: Aspergillus exhibits a wide variation of susceptibility against antifungals according to genetic and environmental factors. Identification to the species level is necessary for appropriate treatment. Our objective was to determine the Aspergillus species involved in invasive pulmonary aspergillosis (IPA) among ICU patients in Jakarta, Indonesia. Methodology: The incidence of IPA in ICU patients at six hospitals in Jakarta from October 2012 – January 2015 was investigated. It involved a collection of endotracheal aspirates (ETA), nasal swabs and environmental samples around the hospitals, phenotypic screening, molecular characterization, and antifungal susceptibility testing. Results: Of the 405 patients investigated, 31 patients (7.7%) were diagnosed with putative IPA, from whom 45 Aspergillus isolates were collected. Aspergillus isolates were identified from pulmonary secretions in 24 patients, from nasal swabs in 7 patients and from both pulmonary secretions and nasal swabs in 7 patients. The phenotypic method showed 33 isolates of Aspergillus flavus (73.4%), nine Aspergillus fumigatus (20%), two Aspergillus niger (4.4%), and one Aspergillus nidulans (2.2%) isolate. Molecular identification showed 27 isolates of A. flavus (60.0%), eight isolates of A. fumigatus (17.8%), two isolates of A. niger (4.4%) and one isolate of A. nidulans (2.2%), while seven isolates (15.6%) were cryptic species or mixed isolates. Conclusions: Susceptibility testing showed all isolates were susceptible to amphotericin B, azoles and micafungin. Aspergillus flavus was the main causative organism in IPA cases in Jakarta, followed by A. fumigatus.

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Antifungal Resistance in Clinical Isolates of Aspergillus spp.: When Local Epidemiology Breaks the Norm

Cited by 27 publications

References 28 publications

Drug-Resistant Fungi: An Emerging Challenge Threatening Our Limited Antifungal Armamentarium

Drug-Resistant Fungi: An Emerging Challenge Threatening Our Limited Antifungal Armamentarium

Suppression effect of thyme and carvacrol nano-emulsions on Aspergillus fumigatus isolated from patients in the intensive care unit of Assiut University Hospital, Egypt

Molecular typing and antifungal susceptibility study of Aspergillus spp. in intensive care unit (ICU) patients in Indonesia

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