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Azole resistance in aspergillosis: The next threat?

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Abstract

During the past years, aspergilli less susceptible to antifungals have begun to emerge, and antifungal drug resistance may partially account for treatment failures. Resistance of Aspergillus fumigatus clinical isolates to itraconazole, voriconazole, and posaconazole has been reported with increasing frequency, although it is considered an uncommon phenomenon. Molecular biologists have begun to shed light on the mechanisms of A. fumigatus resistance to azoles. Several mechanisms of resistance have been described, such as point mutations of cyp51A and reduced concentrations of intracellular drug. The latter mechanism might be the result of either overexpression of efflux pumps or reduced drug penetration. The issue of cross-resistance between the newer triazoles is of concern and depends on cyp51 mutations. Fungal drug resistance is an issue because of the limited number of antifungal compounds. Patients receiving long-term azole treatment are at highest risk for developing multidrug-resistant A. fumigatus infections.

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  1. Department of Hygiene, Microbiology, and Social Medicine, Division of Hygiene and Medical Microbiology, Innsbruck Medical University, 6020, Innsbruck, Tirol, Austria

    Cornelia Lass-Flörl

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  1. Cornelia Lass-Flörl
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Correspondence to Cornelia Lass-Flörl.

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Lass-Flörl, C. Azole resistance in aspergillosis: The next threat?. Curr Fungal Infect Rep 3, 236–242 (2009). https://doi.org/10.1007/s12281-009-0033-7

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