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Handbook of Antimicrobial Resistance pp 403–421Cite as

Azole Resistance in Aspergillus fumigatus: Mechanisms, Route of Resistance Selection, and Clinical Implications

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Abstract

The medical triazoles, itraconazole, voriconazole, and posaconazole, are the most widely used drugs for the management of infections caused by the saprophytic mold Aspergillus fumigatus. However, acquired azole resistance in A. fumigatus is an emerging problem that compromises the clinical efficacy of azole antifungals. Several mutations in the cyp51A gene of A. fumigatus affect the activity of all mold-active antifungal azoles. These mutations result in the complete loss of activity of a specific azole and are commonly associated with cross-resistance to other azoles. While azole resistance may emerge during antifungal therapy of individual azole-treated patients, selection of resistance can also occur in the environment. The selection for azole resistance within the environment poses an emerging global threat as mutations associated with environmental resistance have now been detected with increasing frequency in multiple European countries, Asia, the Middle East, and Africa.

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Authors and Affiliations

  1. Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands

    Seyedmojtaba Seyedmousavi & Paul E. Verweij

  2. Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands

    Seyedmojtaba Seyedmousavi

Authors
  1. Seyedmojtaba Seyedmousavi
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  2. Paul E. Verweij
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Corresponding authors

Correspondence to Seyedmojtaba Seyedmousavi or Paul E. Verweij .

Editor information

Editors and Affiliations

  1. Department of Microbiology and Immunology, McGill University, Montreal, Québec, Canada

    Albert Berghuis

  2. Department of Microbiology and Immunology, McGill University, Montreal, Québec, Canada

    Greg Matlashewski

  3. Department of Microbiology and Immunology, McGill University, Montreal, Québec, Canada

    Mark A. Wainberg

  4. Department of Microbiology and Immunology, McGill University, Montreal, Québec, Canada

    Donald Sheppard

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Seyedmousavi, S., Verweij, P.E. (2017). Azole Resistance in Aspergillus fumigatus: Mechanisms, Route of Resistance Selection, and Clinical Implications. In: Berghuis, A., Matlashewski, G., Wainberg, M., Sheppard, D. (eds) Handbook of Antimicrobial Resistance. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0694-9_22

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