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Azole Antifungal Resistance Today: Focus on Aspergillus

Current Infectious Disease Reports volume 13, Article number: 485 (2011) Cite this article

Abstract

Oral triazole therapy is well established for the treatment of invasive aspergillosis (IPA), allergic aspergillosis (ABPA), and chronic pulmonary aspergillosis (CPA), and is often long-term. Resistance to triazole azole antifungal drugs in Aspergillus fumigatus is now a major clinical problem in a number of European locations, in China, Canada and the USA with particularly high frequencies from the north-west of the UK, and The Netherlands. A number of centers are reporting the continuing increasing frequency and evolution of resistance mechanisms in A. fumigatus, in both azole-naïve and patients treated with azoles. The increasing rate of resistance is of concern. A number of resistance mechanisms have been found. The biofilm modality of Aspergillus growth may have a number of therapeutic implications for aspergillosis, including antifungal resistance. Microbiological diagnosis of aspergillosis is limited by poor culture yield, leading to uncertainty about the frequency of triazole resistance. Direct resistance testing in culture-negative clinical samples may add additional insights into the prevalence of azole resistance in A. fumigatus.

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Disclosure

Paul Bowyer has received a grant from Astra Zeneca and stock options from Alergenetica SL; David W. Denning has served as a consultant for Lab21 Ltd and F2G Ltd, has been employed by The University of Manchester, and the National Institute of Allergy and Infectious Diseases, USA. He has also received grants and honoraria from Pfizer, Astellas, Myconostica, Merck, and Gilead, and patents from Myconostica; Malcolm D. Richardson has been a consultant and honoraria recipient for Gilead, Astellas, Pfizer, Cephalon, and Schering-Plough. He has also received payment for development of educational presentations from Gilead, Astellas, Pfizer, and Schering Plough, as well as travel and accommodation expense reimbursement from Gilead and Astellas. Riina Rautemaa and Caroline B. Moore reported no potential conflicts of interest relevant to this article.

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Affiliations

  1. Manchester Academic Health Science Centre, School of Translational Medicine, The University of Manchester, Manchester, United Kingdom

    Paul Bowyer, Caroline B. Moore, Riina Rautemaa, David W. Denning & Malcolm D. Richardson

  2. University Hospital of South Manchester, Manchester, UK

    Caroline B. Moore, Riina Rautemaa, David W. Denning & Malcolm D. Richardson

  3. Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland

    Riina Rautemaa

  4. Department of Oral Medicine, Institute of Dentistry, University of Helsinki, Helsinki, Finland

    Riina Rautemaa

  5. Mycology Reference Centre, Education and Research Centre, Wythenshawe Hospital, Manchester, M23 9LT, UK

    Malcolm D. Richardson

Authors
  1. Paul Bowyer
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  2. Caroline B. Moore
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  3. Riina Rautemaa
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  4. David W. Denning
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  5. Malcolm D. Richardson
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Corresponding author

Correspondence to Malcolm D. Richardson.

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Bowyer, P., Moore, C.B., Rautemaa, R. et al. Azole Antifungal Resistance Today: Focus on Aspergillus . Curr Infect Dis Rep 13, 485 (2011). https://doi.org/10.1007/s11908-011-0218-4

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  • DOI: https://doi.org/10.1007/s11908-011-0218-4

Keywords

  • Aspergillus fumigatus
  • Azole antifungals
  • Resistance