The prevalence of invasive aspergillosis was increasing during past years. Aspergillus had become one of the most common causes of death in patients with severe immune deficiency. Meanwhile, the sensitivity of aspergillus to azoles decreased significantly worldwide recently. In 2015, we firstly investigated and reported the molecular epidemiology of azole resistance of Aspergillus fumigatus in China. Four azole resistant strains were isolated among 72 clinical strains of A. fumigatus, making the azole resistant rate to 5.56%. Furthermore, we collected 201 strains of A. fumigatus from hospitalized patients in Nanjing during March 2017 to February 2021. We found six strains among them (2.99%) were resistant to both itraconazole and posaconazole. We performed literature reviewing on more than ten relevant reports from China, and found that the azole resistance rate of clinical isolates of A. fumigatus in China was less than 10%. Azole resistance rate of A. fumigatus was higher in east and southeast China, and lower in west and north China. Most of the mutation sites related to azole-resistance are located on cyp51A gene, such as TR34/L98H and TR34/L98H/S297T/F495I. Clinical azole resistant strains of A. fumigatus are sensitive to amphotericin B and its liposomes, echinocandins, etc. In addition, non-cyp51A gene mutations related to azole-resistance of clinical strains of A. fumigatus in China was increasing. Meanwhile, the proportion of A. flavus, A. terreus and A. niger in clinical Aspergillus strains is gradually increasing. Their drug resistance needs to be paid more attention. Azole resistance of A. fumigatus in China is related to agricultural triazole induction.
Audience Take Away Notes:
- The prevalence of azole-resistant A. fumigatus in China
- The mutation mechanism of azole-resistant A. fumigatus identified in China.
- Current situation of the treatment of Aspergillosis in China