Hospital Environment as a Source of Azole-Resistant Strains with TR34/L98H and G448S Cyp51A Mutations.

Azole-resistant is an emerging worldwide problem with increasing reports of therapy failure cases produced by resistant isolates. A case of azole-resistant hospital colonization in a patient is reported here. Investigations of the hospital environment led to the recovery of strains harboring the TR34/L98H and the G448S Cyp51A azole resistance mechanisms. Isolate genotyping showed that one strain from the environment was isogenic with the patient strains. These are the first environmental azole resistant strains collected in a hospital in Spain; it supports the idea of the hospital environment as a source of dissemination and colonization/infection by azole resistant in patients. The isolation of an azole-resistant strain from an azole-naïve patient is an interesting finding, suggesting that an effective analysis of clinical and environmental sources must be done to detect azole resistance in . The emergence and spread of these resistance mechanisms in is of major concern because it confers high resistance to voriconazole and is associated with treatment failure in patients with invasive aspergillosis.