Infection and Drug Resistance (Dec 2020)
Aspergillus Species in Lower Respiratory Tract of Hospitalized Patients from Shanghai, China: Species Diversity and Emerging Azole Resistance
Abstract
Yuan Xu,1,2 Min Chen,2 Junhao Zhu,3 Bert Gerrits van den Ende,4 Amanda Juan Chen,5 Abdullah MS Al-Hatmi,6,7 Li Li,3 Qiangqiang Zhang,3 Jianping Xu,8 Wanqing Liao,2 Yuchong Chen9 1Department of Dermatology, The Third People’s Hospital of Hangzhou, Hangzhou, People’s Republic of China; 2Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, ChangZheng Hospital, Second Military Medical University, Shanghai, People’s Republic of China; 3Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China; 4Department of Food and Indoor Mycology, Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands; 5Department of Medical Mycology, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China; 6Centre of Expertise in Mycology, Radboud University Medical Centre, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands; 7Ministry of Health, Directorate General of Health Services, Ibri, Oman; 8Department of Biology, McMaster University, Hamilton, Canada; 9Department of Dermatosurgery, Shanghai Skin Diseases Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of ChinaCorrespondence: Yuchong Chen Tel/Fax +86-21-61833148Email [email protected] Zhu Tel/Fax +86-21-81885502Email [email protected]: To investigate species diversity and prevalence of antifungal resistance among clinical isolates of Aspergillus spp. in Shanghai, China.Patients and Methods: In this study, the Aspergillus spp. isolates were analyzed by multilocus sequence typing (MLST) targeting the internal transcribed spacer (ITS) regions, and partial β-tubulin (BenA) and calmodulin (CaM) genes. The susceptibilities of these isolates to nine antifungal agents were determined according to the protocol in document M38-A3 established by the Clinical and Laboratory Standards Institute (CLSI).Results: The most common Aspergillus spp. was A. fumigatus (58.2%), followed by the A. flavus complex (23.5%), and A. niger complex (15.3%). Isolates belonging to A. tamarii and A. effusus of the A. flavus complex and A. tubingensis and A. awamori of the A. niger complex were identified. Moreover, several mutations were found in the azole target cyp51A gene (TR46/Y121F/T289A and F46Y, G89G, M172V, N248T and D255E) in azole-resistant isolates of A. fumigatus.Conclusion: The results of our study revealed a diversity of species in the lower respiratory tract of inpatients in Shanghai and approximately 9% of our isolates were resistant to at least one of the triazole antifungals. Formulation of local treatment strategies to combat emerging azole resistance and species diversity in clinically relevant Aspergillus spp. is needed.Keywords: Aspergillus, antifungal susceptibility, identification, molecular typing, China
