Evaluation of the Activity of Triazoles Against Non- and Cryptic Species Causing Invasive Infections Tested in the SENTRY Program.

The activity of isavuconazole and other triazoles against non- (non-AFM) causing invasive aspergillosis was evaluated. A total of 390 non-AFM isolates were collected (1/patient) in 2017-2021 from 41 hospitals. Isolates were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry and/or internal spacer region/β-tubulin sequencing and tested by Clinical and Laboratory Standards Institute (CLSI) broth microdilution. CLSI epidemiological cutoff values were applied, where available. Isavuconazole showed activity against sections (n 122; minimum inhibitory concentration [MIC], 0.5/1 mg/L), (n 57; MIC, 0.5/0.5 mg/L), (n = 34; MIC, 0.12/0.25 mg/L), (n 7; MIC, 1 mg/L), and (n 2; MIC range, 0.12-2 mg/L). Similar activity was displayed by other triazoles against those sections. Most of the isolates from sections (n 9), (n 146), and (n 12) exhibited elevated MIC values to isavuconazole (MIC, 2/-, 2/4, and 2/8 mg/L), voriconazole (MIC, 2/-, 1/2, and 4/8 mg/L), itraconazole (MIC, 2/-, 2/4, and 8/>8 mg/L), and posaconazole (MIC, 0.5/-, 0.5/1, and >8/>8 mg/L), respectively. Isavuconazole was active (MIC values, ≤1 mg/L) against , , , , , , , and , while isavuconazole MIC values between 2 and 8 mg/L were observed against cryptic isolates from section . Isavuconazole inhibited 96.1% of and 80.0% of at ≤4 mg/L, the CLSI wild-type cutoff value for . Voriconazole, itraconazole, and posaconazole showed similar activity to isavuconazole against most cryptic species. Isavuconazole exhibited potent in vitro activity against non-AFM; however, the activity of triazoles varies among and within cryptic species.