Azole Resistance of Aspergillus fumigatus in Immunocompromised Patients with Invasive Aspergillosis

摘要

In Response: Alanio et al. comment that the prevalenceof azole-resistant Aspergillus disease may differ,depending on location of the hospital where patients areadmitted and the patients’ underlying disease (1). Determininglocal or regional epidemiology, especially in areaswhere azole-resistant isolates are found in the environment,is indeed important. These isolates commonly harbor theTR34/L98H or TR46/Y121F/T289A resistance mechanism.Patients may inhale azole-resistant spores in the air andsubsequently develop azole-resistant disease, even whenthey have never been treated with azoles (2). Althoughrisk for inhalation of azole-resistant Aspergillus sporesarguably might be similar for all patients, surveillance ofAspergillus isolates in the Netherlands indicates that resistancerates vary among hospitals. When all A. fumigatusisolates cultured from patients were investigated for azoleresistance, resistance rates in the Netherlands ranged from4.3% to 19.2% in 2013 and 3.8% to 13.3% in 2014 (3). Thehighest and lowest resistance rates were found in hospitalsonly 39 km from each other, supporting the observationmade by Alanio et al. about variations in prevalence ofazole-resistant Aspergillus disease (1).