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

Abstract

Azole-resistant <i>Aspergillus fumigatus</i> is an emerging worldwide problem with increasing reports of therapy failure cases produced by resistant isolates. A case of azole-resistant <i>A. fumigatus</i> hospital colonization in a patient is reported here. Investigations of the hospital environment led to the recovery of <i>A. fumigatus</i> 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 <i>A. fumigatus</i> 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 <i>A. fumigatus</i> 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 <i>A. fumigatus</i>. The emergence and spread of these resistance mechanisms in <i>A. fumigatus</i> is of major concern because it confers high resistance to voriconazole and is associated with treatment failure in patients with invasive aspergillosis.