Abstract
Antifungal surveillance is an important tool to monitor the prevalence of uncommon fungal species and increasing antifungal resistance throughout the world, but data comparing results across several different Asian countries are scarce. In this study, 372 invasive molds collected in the Asia-Western Pacific region in 2011–2019 were susceptibility tested for mold-active triazoles (isavuconazole, posaconazole, voriconazole, and itraconazole). The collection includes 318 Aspergillus spp. isolates and 53 non-Aspergillus molds. The MIC values using CLSI methods for isavuconazole versus Aspergillus fumigatus ranged from 0.25 to 2 mg l−1. Isavuconazole, itraconazole, posaconazole, and voriconazole acted similarly against A. fumigatus. The mold-active triazoles exhibited a wildtype phenotype to most of the Aspergillus spp. isolates tested (>94%), but poor activity against Fusarium solani species complex and Lomentospora prolificans. Voriconazole was most active against the Scedosporium spp. and posaconazole was most active against the Mucorales. In summary, isavuconazole displayed excellent activity against most species of Aspergillus and was comparable to other mold-active triazoles against non-Aspergillus molds.
Highlights
Invasive mold infections (IMI) threaten to limit the lifesaving advances of modern medical technology [1,2,3]
We summarized the results of the APAC component of the SENTRY Program between 2011 and 2019, comparing the activities of four mold-active triazoles tested against a collection of 372 invasive molds, including Aspergillus spp (318 isolates), Mucorales (13 isolates), Scedosporium spp (17 isolates), and 12 different species of other rare molds (23 isolates)
If the epidemiological cutoff values (ECVs) for posaconazole were to be set at 0.5 mg l−1, 98.9% of A. fumigatus isolates in this collection would be WT
Summary
Invasive mold infections (IMI) threaten to limit the lifesaving advances of modern medical technology [1,2,3]. Conventional microscopy and culture are available in most settings, few laboratories perform nucleic acid sequencing or matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for fungal identification and antifungal susceptibility testing is rarely performed on filamentous fungi [8]. These limitations highlight the need for quality laboratory support, training in medical mycology, and improved access to modern medical technology to facilitate the diagnosis and treatment of IMI in the APAC region [8]
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