Manchester Academic Health Science Centre, School of Translational Medicine, The University of Manchester, Manchester, United Kingdom.
Curr Infect Dis Rep. 2011 Dec;13(6):485-91. doi: 10.1007/s11908-011-0218-4.
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.
口服三唑类药物治疗已广泛用于侵袭性曲霉病（IPA）、变应性支气管肺曲霉病（ABPA）和慢性肺曲霉病（CPA），且通常为长期治疗。烟曲霉对三唑类抗真菌药物的耐药性目前是许多欧洲地区、中国、加拿大和美国的一个主要临床问题，英国西北部和荷兰的耐药率尤其高。许多中心报告称，在唑类药物初治和治疗的患者中，烟曲霉的耐药机制不断增加且在演变，包括唑类耐药。耐药率的增加令人担忧。现已发现多种耐药机制。曲霉生长的生物膜方式可能对曲霉病有多种治疗意义，包括抗真菌耐药性。曲霉病的微生物学诊断受到培养产量差的限制，导致对三唑类耐药的频率不确定。在培养阴性的临床样本中进行直接耐药检测，可能有助于进一步了解烟曲霉中唑类耐药的流行情况。
