ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2011
High-frequency triazole resistance found In nonculturable Aspergillus fumigatus from lungs of patients with chronic fungal disease.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 131 papers, 3 of them syntheses that pooled it.
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Who cites it
131 citing papers in PubMed, 3 syntheses or guidelines pooled it, 311 citations in OpenAlex.
- Aspergillus fumigatus-a systematic review to inform the World Health Organization priority list of fungal pathogens.Medical mycology · 2024Pooled it
- Healthcare Utilization and Impact of Antifungal Stewardships Within Respiratory Care Settings: A Systematic Literature Review.Mycopathologia · 2021Pooled it
- Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Guideline
- Impact of allergic bronchopulmonary aspergillosis overlap in chronic pulmonary aspergillosis.ERJ open research · 2026Article
- Molecular Mechanisms, Diagnosis, and Therapeutic Strategies of Antifungal Resistance in Filamentous Fungi.Journal of fungi (Basel, Switzerland) · 2026Review
- Azole Resistance inOpen forum infectious diseases · 2026Article
- Evaluation of anAntimicrobial agents and chemotherapy · 2026Article
- Concordance between different methods of detecting fungal-specific IgE antibody in asthma.Frontiers in allergy · 2026Article
- Integrative diagnosis of invasive pulmonary aspergillosis in non-neutropenic patients using BALF-tNGS-derivedFrontiers in cellular and infection microbiology · 2026Article
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- Invasive Aspergillosis with Secondary Bacterial Infection withJournal of pharmacy & bioallied sciences · 2025Article
- Loss of theMicrobiology spectrum · 2025Article
- Deadly Decomposers: Distinguishing Life History Strategies on the Parasitism-Saprotrophy Spectrum.Ecology letters · 2025Review
- Value of plasma metagenomic next-generation sequencing for the diagnosis of invasive aspergillosis: a multicenter-center retrospective study.Frontiers in cellular and infection microbiology · 2025Observational
- Review
- Performance of rapid on-site evaluation of touch imprints of bronchoscopic biopsies or lung tissue biopsies for the diagnosis of invasive pulmonary filamentous fungi infections in non-neutropenic patients.Journal of clinical microbiology · 2024Article
- Post-Coronavirus Disease 2019 Pandemic Antimicrobial Resistance.Antibiotics (Basel, Switzerland) · 2024Review
- Effect of conjugative transfer of antibiotic resistance genes mediated by plasmids on the microecology of different intestinal segments.Frontiers in microbiology · 2024Article
- The Microevolution of Antifungal Drug Resistance in Pathogenic Fungi.Microorganisms · 2023Review
- Diagnostic Laboratory Features and Performance of anMicrobiology spectrum · 2023Article
71 more citing papers are in PubMed but not listed here.
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Authors and funding
11 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundOral triazole therapy is well established for the treatment of invasive (IPA), allergic (ABPA), and chronic pulmonary (CPA) aspergillosis, and is often long-term. Triazole resistance rates are rising internationally. Microbiological diagnosis of aspergillosis is limited by poor culture yield, leading to uncertainty about the frequency of triazole resistance.
methodsUsing an ultrasensitive real-time polymerase chain reaction (PCR) assay for Aspergillus spp., we assessed respiratory fungal load in bronchoalveolar lavage (BAL) and sputum specimens. In a subset of PCR-positive, culture negative samples, we further amplified the CYP51A gene to detect key single-nucleotide polymorphisms (SNPs) associated with triazole resistance.
resultsAspergillus DNA was detected in BAL from normal volunteers (4/11, 36.4%) and patients with culture or microscopy confirmed IPA (21/22, 95%). Aspergillus DNA was detected in sputum in 15 of 19 (78.9%) and 30 of 42 (71.4%) patients with ABPA and CPA, compared with 0% and 16.7% by culture, respectively. In culture-negative, PCR-positive samples, we detected triazole-resistance mutations (L98H with tandem repeat [TR] and M220) within the drug target CYP51A in 55.1% of samples. Six of 8 (75%) of those with ABPA and 12 of 24 (50%) with CPA had resistance markers present, some without prior triazole treatment, and in most despite adequate plasma drug concentrations around the time of sampling.
conclusionsThe very low organism burdens of fungi causing infection have previously prevented direct culture and detection of antifungal resistance in clinical samples. These findings have major implications for the sustainability of triazoles for human antifungal therapy.
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