Genomic epidemiology identifies azole resistance due to TR₃₄/L98H in European Aspergillus fumigatus causing COVID-19-associated pulmonary aspergillosis
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Published version
Author(s)
Type
Journal Article
Abstract
Aspergillus fumigatus has been found to coinfect patients with severe SARS-CoV-2 virus infection, leading to COVID-19-associated pulmonary aspergillosis (CAPA). The CAPA all-cause mortality rate is approximately 50% and may be complicated by azole resistance. Genomic epidemiology can help shed light on the genetics of A. fumigatus causing CAPA, including the prevalence of resistance-associated alleles. We present a population genomic analysis of 21 CAPA isolates from four European countries with these isolates compared against 240 non-CAPA A. fumigatus isolates from a wider population. Bioinformatic analysis and antifungal susceptibility testing were performed to quantify resistance and identify possible genetically encoded azole-resistant mechanisms. The phylogenetic analysis of the 21 CAPA isolates showed that they were representative of the wider A. fumigatus population with no obvious clustering. The prevalence of phenotypic azole resistance in CAPA was 14.3% (n = 3/21); all three CAPA isolates contained a known resistance-associated cyp51A polymorphism. The relatively high prevalence of azole resistance alleles that we document poses a probable threat to treatment success rates, warranting the enhanced surveillance of A. fumigatus genotypes in these patients. Furthermore, potential changes to antifungal first-line treatment guidelines may be needed to improve patient outcomes when CAPA is suspected.
Date Issued
2023-11
Date Acceptance
2023-11-03
Citation
Journal of Fungi, 2023, 9 (11), pp.1104-1104
ISSN
2309-608X
Publisher
MDPI AG
Start Page
1104
End Page
1104
Journal / Book Title
Journal of Fungi
Volume
9
Issue
11
Copyright Statement
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
License URL
Identifier
http://dx.doi.org/10.3390/jof9111104
Publication Status
Published
Article Number
1104
Date Publish Online
2023-11-13