Azole resistance in Aspergillus: global status in Europe and Asia

Azole-resistant strains of Aspergillus have been reported from European and Asian countries at varying frequencies. Based on the limited rates of isolation of Aspergillus from clinical samples in routine practice and the limited number of the screening studies carried out so far, the true prevalence of triazole resistance and the rate of multiazole-resistant strains remain partly unknown. Also, available data are mostly for A. fumigatus (complex), thus the situation for non-fumigatus Aspergilli is less clear. In general, exposure of Aspergillus to antifungal agents via medical or environmental (agricultural) use of these compounds appears to have the possible major impact on acquisition of triazole resistance. Azole resistance in Aspergillus remains to be further elucidated by continued surveillance studies. Based on the possible association with agricultural azole use, environmental sampling appears significant as well.