Multicenter Study of Susceptibility of Aspergillus Species Isolated from Iranian University Hospitals to Seven Antifungal Agents

Microbiology Spectrum

Kambiz Diba¹  Hadis Jafarian²  Parisa Badiee²  Fatemeh Ghasemi²  Maneli Amin Shahidi²  Tahereh Shokohi³  Seyyed Amin Ayatollahi Mousavi⁴  Mohammad Javad Najafzadeh⁵  Rasoul Mohammadi⁶  Ali Reza Salimi-Khorashad⁷  Abdolkarim Ghadimi-Moghadam⁸  Jafar Soltani⁹  Ali Zarei Mahmoudabadi^1,10  Jamal Hashemi^1,11  Teun Boekhout^1,12 

[1] Cellular and Molecular Research Center, Urmia University of Medical Sciences, Urmia, Iran;Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran;Department of Medical Mycology, School of Medicine, Invasive Fungi Research Centre (IFRC), Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran;Department of Medical Parasitology and Mycology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran;Department of Medical Parasitology and Mycology, Mashhad University of Medical Sciences, Mashhad, Iran;Department of Medical Parasitology and Mycology, School of Medicine, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran;Department of Parasitology and Mycology, School of Medicine, Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, Iran;Department of Pediatrics Infectious Disease, Emmam Sajjad Hospital, Yasuj University of Medical Sciences, Yasuj, Iran;Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran;Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran;Medical Mycology Department, School of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran;Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands;

关键词: amphotericin B;    antifungal susceptibility;    Aspergillus;    azoles;    echinocandins;    Iran;   

DOI  :  10.1128/spectrum.02539-21

来源: DOAJ

【 摘 要 】

ABSTRACT Aspergillus species are a major cause of life-threatening invasive infections and noninvasive diseases. This study seeks to investigate the frequency of Aspergillus species among Iranian patients and their susceptibility to seven antifungals. In a cross-sectional study, 233 Aspergillus isolates were collected from 11 university hospitals in Iran between 2018 and 2021. Aspergillus isolates were identified based on colony morphology, microscopic characteristics, PCR-restriction fragment length polymorphism (RFLP), and sequencing of the beta-tubulin gene. The CLSI M38-A2 reference methodology was used for antifungal susceptibility testing of amphotericin B, voriconazole, posaconazole, itraconazole, luliconazole, isavuconazole, and caspofungin. Members of Aspergillus section Flavi (117/233, 50.2%), Aspergillus section Nigri (77/233, 33.1%), Aspergillus section Fumigati (21/233, 9%), Aspergillus section Terrei (14/233, 6%), Aspergillus pseudodeflectus (2/233, 0.85%), and Aspergillus melleus (2/233, 0.85%) were isolated from the samples. The lowest 0.25 MIC90 values for all isolates tested were for luliconazole (0.016 μg/mL) and isavuconazole (0.250 μg/mL), and the highest value was observed for itraconazole (≥ 8μg/mL). The 90% minimum effective concentration (MEC90) value for caspofungin was 0.125 μg/mL. MIC90 values for voriconazole, amphotericin B, and posaconazole were 1, 2, and 2 μg/mL, respectively. The non-wild-type species were presented for amphotericin B (3%), voriconazole (1.3%), posaconazole (2.6%), luliconazole (1.3%), isavuconazole (1.7%), and caspofungin (4.7%). Positive correlations in the MIC values of azole antifungals were observed, and using one azole increases the MIC value rates of other ones. None of the species were pan-azole resistant. Species of Aspergillus section Flavi were the most common Aspergillus species isolated from Iranian samples. Luliconazole, caspofungin, and isavuconazole present the most effective antifungal agents for treatment of infection due to Aspergillus species. Susceptibility tests should be performed frequently in each region for the best management of patients. IMPORTANCE Aspergillus species are the leading cause of invasive aspergillosis in immunocompromised hosts. The susceptibility of Aspergillus species to antifungal agents might be different. Azole-resistant species have emerged worldwide. Performing susceptibility testing in each region can help in the best management of patients. Here, we show the epidemiology and distribution of Aspergillus species in Iran and their susceptibility patterns for seven antifungal agents. The significant points of the present study are that species of Aspergillus section Flavi are the most prevalent Aspergillus species isolated from 11 university hospitals. Luliconazole, caspofungin, and isavuconazole were effective antifungal agents against all Aspergillus species.

【 授权许可】

Unknown