ArticleAntimicrobial agents and chemotherapy2013
cyp51A-Based mechanisms of Aspergillus fumigatus azole drug resistance present in clinical samples from Germany.
Article in Antimicrobial agents and chemotherapy, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 71 papers.
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71 citing papers in PubMed.
- Molecular and Phenotypic Characterization of Multidrug-ResistantJournal of fungi (Basel, Switzerland) · 2026Article
- Genotype-Phenotype Relationships in Azole-ResistantJournal of fungi (Basel, Switzerland) · 2026Review
- Directed evolution of the pathogenic moldAntimicrobial agents and chemotherapy · 2026Article
- Aspergillosis: A comprehensive review of pathogenesis, drug resistance, and emerging therapeutics.Journal of food and drug analysis · 2025Review
- The Dual PathogenJournal of fungi (Basel, Switzerland) · 2025Review
- Comprehensive Review of Environmental Surveillance for Azole-ResistantJournal of fungi (Basel, Switzerland) · 2025Review
- Molecular Identification ofInfection and drug resistance · 2025Article
- The role of gene copy number variation in antimicrobial resistance in human fungal pathogens.npj antimicrobials and resistance · 2025Review
- High prevalence of azole resistance among environmentalFrontiers in microbiology · 2025Article
- What do We Know about Cryptic Aspergillosis?Microorganisms · 2024Review
- Genomic diversity of the pathogenic fungus Aspergillus fumigatus in Japan reveals the complex genomic basis of azole resistance.Communications biology · 2024Article
- Antifungal Susceptibility and Genotypic Analysis ofInfection and drug resistance · 2024Article
- Clinical Implementation ofJournal of fungi (Basel, Switzerland) · 2023Article
- Drug-ResistantPathogens (Basel, Switzerland) · 2023Review
- Reduced Susceptibility to Azoles in Cryptococcus gattii Correlates with the Substitution R258L in a Substrate Recognition Site of the Lanosterol 14-α-Demethylase.Microbiology spectrum · 2023Article
- Clinical epidemiology of pulmonary aspergillosis in hospitalized patients and contribution of Cyp51A, Yap1, and Cdr1B mutations to voriconazole resistance in etiologic Aspergillus species.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2023Article
- Diagnosis of invasive fungal infections: challenges and recent developments.Journal of biomedical science · 2023Review
- Potency of olorofim (F901318) compared to contemporary antifungal agents against clinicalAntimicrobial agents and chemotherapy · 2023Article
- Genetic Structure and Triazole Antifungal Susceptibilities of Alternaria alternata from Greenhouses in Kunming, China.Microbiology spectrum · 2022Article
- Genetic Diversity and Azole Resistance Among Natural Aspergillus fumigatus Populations in Yunnan, China.Microbial ecology · 2022Article
11 more citing papers are in PubMed but not listed here.
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Abstract
Since the mid-1990s, a steady increase in the occurrence of itraconazole-resistant Aspergillus fumigatus isolates has been observed in clinical contexts, leading to therapeutic failure in the treatment of aspergillosis. This increase has been predominantly linked to a single allele of the cyp51A gene, termed TR/L98H, which is thought to have arisen through the use of agricultural azoles. Here, we investigated the current epidemiology of triazole-resistant A. fumigatus and underlying cyp51A mutations in clinical samples in Germany. From a total of 527 samples, 17 (3.2%) showed elevated MIC0 values (the lowest concentrations with no visible growth) for at least one of the three substances (itraconazole, voriconazole, and posaconazole) tested. The highest prevalence of resistant isolates was observed in cystic fibrosis patients (5.2%). Among resistant isolates, the TR/L98H mutation in cyp51A was the most prevalent, but isolates with the G54W and M220I substitutions and the novel F219C substitution were also found. The isolate with the G54W substitution was highly resistant to both itraconazole and posaconazole, while all others showed high-level resistance only to itraconazole. For the remaining six isolates, no mutations in cyp51A were found, indicating the presence of other mechanisms. With the exception of the strains carrying the F219C and M220I substitutions, many itraconazole-resistant strains also showed cross-resistance to voriconazole and posaconazole with moderately increased MIC0 values. In conclusion, the prevalence of azole-resistant A. fumigatus in our clinical test set is lower than that previously reported for other countries. Although the TR/L98H mutation frequently occurs among triazole-resistant strains in Germany, it is not the only resistance mechanism present.
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