Prevalence and in vitro antifungal susceptibility of cryptic species of the genus Aspergillus isolated in clinical samples

Distribution of Aspergillus species and prevalence of azole resistance in clinical and environmental samples from a Spanish hospital during a three-year study period

BACKGROUND

Surveillance studies are crucial for updating trends in Aspergillus species and antifungal susceptibility information.

OBJECTIVES

Determine the Aspergillus species distribution and azole resistance prevalence during this 3-year prospective surveillance study in a Spanish hospital.

MATERIALS AND METHODS

Three hundred thirty-five Aspergillus spp. clinical and environmental isolates were collected during a 3-year study. All isolates were screened for azole resistance using an agar-based screening method and resistance was confirmed by EUCAST antifungal susceptibility testing. The azole resistance mechanism was confirmed by sequencing the cyp51A gene and its promoter. All Aspergillus fumigatus strains were genotyped using TRESPERG analysis.

RESULTS

Aspergillus fumigatus was the predominant species recovered with a total of 174 strains (51.94%). The rest of Aspergillus spp. were less frequent: Aspergillus niger (14.93%), Aspergillus terreus (9.55%), Aspergillus flavus (8.36%), Aspergillus nidulans (5.37%) and Aspergillus lentulus (3.28%), among other Aspergillus species (6.57%). TRESPERG analysis showed 99 different genotypes, with 72.73% of the strains being represented as a single genotype. Some genotypes were common among clinical and environmental A. fumigatus azole-susceptible strains, even when isolated months apart. We describe the occurrence of two azole-resistant A. fumigatus strains, one clinical and another environmental, that were genotypically different and did not share genotypes with any of the azole-susceptible strains.

CONCLUSIONS

Aspergillus fumigatus strains showed a very diverse population although several genotypes were shared among clinical and environmental strains. The isolation of azole-resistant strains from both settings suggest that an efficient analysis of clinical and environmental sources must be done to detect azole resistance in A. fumigatus.

Aspergilli series Versicolores: importance of species identification in the clinical setting

The moulds of the genus Aspergillus section Nidulantes series Versicolores are ubiquitous and particularly recurrent in indoor air. They are considered present in 70% of the bioaerosols to which we are exposed most of our time spent indoors. With the taxonomic revision proposed in 2012 and the discovery of four new species, the series Versicolores currently includes 18 species. These moulds, although considered as cryptic (except Aspergillus sydowii), are opportunistic pathogens that can exhibit increased minimal inhibitory concentrations to conventional antifungal agents. In this review, we discuss the ecology and clinical implications of each species belonging to the series Versicolores. This survey also highlights the lack of consideration for taxonomic revisions in clinical practice and in scientific studies which greatly limits the acquisition of specific knowledge on species belonging to the series Versicolores.

Draft Genome Sequences of Three Airborne Aspergilli Series Versicolores

The Aspergilli of the section Nidulantes series Versicolores are among the most recurrent molds in indoor environments. These species cause damage to the quality of air. Indeed, they are responsible for allergies, aggravation of asthma and can even cause infections in immunocompromised patients. Molds belonging to the Versicolores series also produce sterigmatocystin, a mycotoxin classified as potential human carcinogen by the International Agency for Research on Cancer (group 2B). Here, we provide for the first time the genome of three species of the series Versicolores: Aspergillus creber, Aspergillus jensenii and Aspergillus protuberus which are the most abundant species of this series in bioaerosols. The genomes of these three species could be assembled with a percentage of completeness of 97.02%, 96.21% and 95.35% for Aspergillus creber, A. jensenii and A. protuberus respectively. These data will allow to study the genes and gene clusters responsible for the expression of virulence factors, the biosynthesis of mycotoxins and the proliferation of these ubiquitous and recurrent molds.

Azole resistance survey on clinical Aspergillus fumigatus isolates in Spain

OBJECTIVES

We aimed to assess the percentage of azole resistance in Aspergillus fumigatus in Spain.

METHODS

Thirty participating Spanish hospitals stored all morphologically identified A. fumigatus sensu lato clinical isolates-regardless their clinical significance-from 15 February to 14 May 2019. Isolates showing azole resistance according to the EUCAST 9.3.2 methodology were molecularly identified and the cyp51A gene was studied in A. fumigatus sensu stricto isolates.

RESULTS

Eight hundred and forty-seven isolates from 725 patients were collected in 29 hospitals (A. fumigatus sensu stricto (n = 828) and cryptic species (n = 19)). Isolates were mostly from the lower respiratory tract (94.0%; 797/847). Only cryptic species were amphotericin B resistant. Sixty-three (7.4%) out of the 847 isolates were resistant to ≥1 azole(s). Azole resistance was higher in cryptic species than in A. fumigatus sensu stricto (95%, 18/19 vs. 5.5%, 45/828); isavuconazole was associated to the lowest number of non-wild type isolates. The dominant mechanism of resistance was the presence of TR₃₄-L98H substitutions (n = 24 out of 63). Out of the 725 patients, 48 (6.6%) carried either cryptic species (n = 14) or A. fumigatus sensu stricto (n = 34; 4.7%) resistant isolates. Aspergillus fumigatus sensu stricto harbouring either the TR₃₄-L98H (n = 19) or TR₄₆/Y121F/T289A (n = 1) mutations were detected in patients in hospitals located at 7/24 studied cities.

DISCUSSION

Of the patients, 6.6% carry azole-resistant A. fumigatus sensu lato isolates in Spain. TR₃₄-L98H is the dominant cyp51A gene substitutions, although its presence is not widespread.