da Fonseca Lívia Maria Maciel, Braga Vanessa Fávaro, Tonani Ludmilla, Grizante Barião Patrícia Helena, Nascimento Erika, Martinez Roberto, von Zeska Kress Marcia Regina
Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão, Universidade de Sao Paulo, Ribeirao Preto 14040-903, Brazil.
Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirao Preto 14040-900, Brazil.
J Fungi (Basel). 2023 Nov 1;9(11):1070. doi: 10.3390/jof9111070.
The genus harbors human infection-causing pathogens and is involved in the complex one-health challenge of antifungal resistance. Here, a 6-year retrospective study was conducted with spp. isolated from patients with invasive, chronic, and clinically suspected aspergillosis in a tertiary teaching hospital. A total of 64 spp. clinical isolates were investigated regarding molecular identification, biofilm, virulence in , antifungal susceptibility, and resistance to amphotericin B and azoles. section (, 62.5%) and section (, 20.3%; , 14%; and , 3.1%) have been identified. section clinical isolates were more virulent than section clinical isolates. Furthermore, scant evidence supports a link between biofilm formation and virulence. The susceptibility of the spp. clinical isolates to itraconazole, posaconazole, voriconazole, and amphotericin B was evaluated. Most spp. clinical isolates (67.2%) had an AMB MIC value equal to or above 2 µg/mL, warning of a higher probability of therapeutic failure in the region under study. In general, the triazoles presented MIC values above the epidemiological cutoff value. The high triazole MIC values of clinical isolates were investigated by sequencing the promoter region and locus. The Cyp51A amino acid substitutions F46Y, M172V, N248T, N248K, D255E, and E427K were globally detected in 47.5% of clinical isolates, and most of them are associated with high triazole MICs. Even so, the findings support voriconazole or itraconazole as the first therapeutic choice for treating infections. This study emphasizes the significance of continued surveillance of spp. infections to help overcome the gap in knowledge of the global fungal burden of infections and antifungal resistance, supporting public health initiatives.
该属含有引起人类感染的病原体，并涉及抗真菌耐药性这一复杂的“同一健康”挑战。在此，我们对一家三级教学医院中从侵袭性、慢性和临床疑似曲霉病患者分离出的曲霉菌进行了一项为期6年的回顾性研究。共对64株曲霉菌临床分离株进行了分子鉴定、生物膜、在秀丽隐杆线虫中的毒力、抗真菌药敏以及对两性霉素B和唑类药物耐药性的研究。已鉴定出烟曲霉组（占62.5%）和非烟曲霉组（黄曲霉占20.3%；黑曲霉占14%；土曲霉占3.1%）。烟曲霉组临床分离株比非烟曲霉组临床分离株的毒力更强。此外，几乎没有证据支持生物膜形成与毒力之间存在联系。评估了曲霉菌临床分离株对伊曲康唑、泊沙康唑、伏立康唑和两性霉素B的敏感性。大多数曲霉菌临床分离株（67.2%）的两性霉素B最低抑菌浓度（MIC）值等于或高于2 µg/mL，这警示在本研究地区治疗失败的可能性更高。总体而言，三唑类药物的MIC值高于流行病学临界值。通过对启动子区域和Cyp51A基因座进行测序，研究了曲霉菌临床分离株的高三唑MIC值。在47.5%的曲霉菌临床分离株中普遍检测到Cyp51A氨基酸取代F46Y、M172V、N248T、N248K、D255E和E427K，其中大多数与高三唑MIC值相关。即便如此，研究结果支持将伏立康唑或伊曲康唑作为治疗曲霉菌感染的首选治疗药物。本研究强调了持续监测曲霉菌感染的重要性，以帮助弥补全球真菌感染负担和抗真菌耐药性知识方面的差距，支持公共卫生举措。
