Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
Antimicrob Agents Chemother. 2013 Jun;57(6):2815-20. doi: 10.1128/AAC.02487-12. Epub 2013 Apr 29.
Aspergillus fumigatus complex comprises A. fumigatus and other morphologically indistinguishable cryptic species. We retrospectively studied 362 A. fumigatus complex isolates (353 samples) from 150 patients with proven or probable invasive aspergillosis or aspergilloma (2, 121, and 6 samples, respectively) admitted to the hospital from 1999 to 2011. Isolates were identified using the β-tubulin gene, and only 1 isolate per species found in each sample was selected. Antifungal susceptibility to azoles was determined using the CLSI M38-A2 procedure. Isolates were considered resistant if they showed an MIC above the breakpoints for itraconazole, voriconazole, or posaconazole (>2, >2, or >0.5 μg/ml). Most of the samples yielded only 1 species (A. fumigatus [n = 335], A. novofumigatus [n = 4], A. lentulus [n = 3], A. viridinutans [n = 1], and Neosartorya udagawae [n = 1]). The remaining samples yielded a combination of 2 species. Most of the patients were infected by a single species (A. fumigatus [n = 143] or A. lentulus [n = 2]). The remaining 5 patients were coinfected with multiple A. fumigatus complex species, although A. fumigatus was always involved; 4 of the 5 patients were diagnosed in 2009 or later. Cryptic species were less susceptible than A. fumigatus. The frequency of resistance among A. fumigatus complex and A. fumigatus to itraconazole, voriconazole, and posaconazole was 2.5 and 0.3%, 3.1 and 0.3%, and 4.2 and 1.8%, respectively, in the per-isolate analysis and 1.3 and 0.7%, 2.6 and 0.7%, and 6 and 4% in the per-patient analysis. Only 1 of the 6 A. fumigatus isolates in which the cyp51A gene was sequenced had a mutation at position G448. The proportion of patients infected by azole-resistant A. fumigatus isolates was low.
烟曲霉复合体包括烟曲霉和其他形态上无法区分的隐种。我们回顾性研究了 1999 年至 2011 年间 150 名确诊或疑似侵袭性曲霉病或曲霉肿患者的 362 株烟曲霉复合体分离株（分别为 353 份样本）。使用β-微管蛋白基因鉴定分离株，并且从每个样本中仅选择每种物种的 1 个分离株。使用 CLSI M38-A2 程序测定抗真菌药物对唑类药物的敏感性。如果 MIC 高于伊曲康唑、伏立康唑或泊沙康唑的折点 (>2、>2 或 >0.5 μg/ml)，则认为分离株耐药。大多数样本仅产生 1 个种（烟曲霉[n=335]、新构巢曲霉[n=4]、腊叶芽枝霉[n=3]、绿木霉[n=1]和 Neosartorya udagawae[n=1]）。其余样本产生了 2 个种的组合。大多数患者感染了单个种（烟曲霉[n=143]或腊叶芽枝霉[n=2]）。其余 5 名患者同时感染了多种烟曲霉复合体种，但总是涉及烟曲霉；5 名患者中的 4 名于 2009 年或之后确诊。隐种比烟曲霉的敏感性低。在每个分离株分析中，烟曲霉复合体和烟曲霉对伊曲康唑、伏立康唑和泊沙康唑的耐药率分别为 2.5%和 0.3%、3.1%和 0.3%和 4.2%和 1.8%，在每位患者的分析中分别为 1.3%和 0.7%、2.6%和 0.7%和 6%和 4%。在测序的 6 株烟曲霉分离株中，只有 1 株在 Cyp51A 基因的位置 G448 发生了突变。感染唑类耐药烟曲霉分离株的患者比例较低。
