Evidence map›Paper›PMID 41343218›Full record

ArticleJAMA network open2025

Triazole Resistance and Misidentification of Aspergillus tubingensis in Southern California.

Yashan Wang, Maliha Aziz, Kaeley Bush, Gregg S Davis, Jeffrey T Foster, Søren Hallstrøm, Amber Jones, Paul S Keim, Reed Leventis, Cindy M Liu and 14 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Epidemiological Characteristics of ClinicalJournal of fungi (Basel, Switzerland) · 2026
    Article
  3. Article
  4. Article
  5. Diagnostic criteria for invasive pulmonary aspergillosis in COPD patients.American journal of respiratory and critical care medicine · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors.

Yashan WangDepartment of Environmental and Occupational Health, Antibiotic Resistance Action Center, The George Washington University, Washington, DC.
Maliha AzizDepartment of Environmental and Occupational Health, Antibiotic Resistance Action Center, The George Washington University, Washington, DC.
Kaeley BushDepartment of Environmental and Occupational Health, Antibiotic Resistance Action Center, The George Washington University, Washington, DC.
Gregg S DavisDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
Jeffrey T FosterPathogen and Microbiome Institute, Northern Arizona University, Flagstaff.
Søren HallstrømDepartment for Sequencing and Bioinformatics, Statens Serum Institut, Copenhagen, Denmark.
Amber JonesPathogen and Microbiome Institute, Northern Arizona University, Flagstaff.
Paul S KeimPathogen and Microbiome Institute, Northern Arizona University, Flagstaff.
Reed LeventisDepartment of Environmental and Occupational Health, Antibiotic Resistance Action Center, The George Washington University, Washington, DC.
Cindy M LiuDepartment of Environmental and Occupational Health, Antibiotic Resistance Action Center, The George Washington University, Washington, DC.
Sydney G NelsonDepartment of Environmental and Occupational Health, Antibiotic Resistance Action Center, The George Washington University, Washington, DC.
Daniel E ParkDepartment of Environmental and Occupational Health, Antibiotic Resistance Action Center, The George Washington University, Washington, DC.
Magdalena PomichowskiDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
Vanessa QuinlivanDepartment of Environmental and Occupational Health, Antibiotic Resistance Action Center, The George Washington University, Washington, DC.
Emily RayensDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
Jason W SahlPathogen and Microbiome Institute, Northern Arizona University, Flagstaff.
June SassDepartment of Environmental and Occupational Health, Antibiotic Resistance Action Center, The George Washington University, Washington, DC.
Jessica SkelaDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
Edward SungDepartment of Environmental and Occupational Health, Antibiotic Resistance Action Center, The George Washington University, Washington, DC.
Jack VillaniDepartment of Global Health, The George Washington University, Washington, DC.
Matthew ZimmermanCenter for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey.
Marc SteggerDepartment of Environmental and Occupational Health, Antibiotic Resistance Action Center, The George Washington University, Washington, DC.
Sara Y TartofDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
Lance B PriceDepartment of Environmental and Occupational Health, Antibiotic Resistance Action Center, The George Washington University, Washington, DC.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Importance: Accurate species identification and antifungal susceptibility testing are essential for effective aspergillosis treatment. However, non-Aspergillus fumigatus species, such as Aspergillus tubingensis, are often misidentified and understudied, potentially compromising proper prognosis and treatment. Objective: To examine the species and prevalence of triazole resistance among clinical Aspergillus isolates in Southern California. Design, Setting, and Participants: This cross-sectional study collected clinical Aspergillus cultures from September 1, 2019, to June 30, 2023, at Kaiser Permanente Southern California, an integrated health system serving a diverse regional population. Triazole susceptibility testing and whole genome sequencing were performed on selected isolates. A total of 2421 consecutive Aspergillus cultures were included. Eighty putative Aspergillus niger isolates were selected for sequencing, including 44 with positive growth in the presence of at least one clinically relevant triazole. Main Outcomes and Measures: The primary outcome was the genome-based species identification of A tubingensis. The secondary outcome was triazole susceptibility above the A niger epidemiological cut-off values. The hypothesis that A tubingensis is a prevalent, underrecognized, triazole-resistant pathogen was developed during data collection. Results: Of 2421 cultures, 1835 were successfully cultured for Aspergillus. After purification and deduplication, 1505 isolates were screened for triazole resistance. A substantial fraction of putative A niger isolates grew at the A niger epidemiological cut-off for itraconazole (110 of 664 [15.1%]). DNA sequencing revealed that 59 of 80 putative A niger isolates (73.8%) were actually A tubingensis. Elevated triazole minimum inhibitory concentrations were not strongly associated with any known cyp51 mutations among the A tubingensis isolates. Conclusions and Relevance: In this cross-sectional study of Aspergillus isolates from Kaiser Permanente Southern California, A tubingensis was a prevalent but underrecognized cause of aspergillosis in Southern California. Its frequent misidentification, association with invasive infections, and triazole resistance underscore the need for improved diagnostics and species-specific epidemiological investigations.

Indexed as

Antifungal AgentsAspergillosisAspergillusTriazolesAspergillus nigerCaliforniaCross-Sectional StudiesDNA, FungalDrug Resistance, FungalHumansItraconazoleMicrobial Sensitivity TestsPrevalenceVoriconazoleWhole Genome SequencingAntifungal AgentsDNA, FungalItraconazoleposaconazoleTriazolesVoriconazole

Identifiers

PMID41343218
PMCPMC12679326

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.