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Journal of Clinical Microbiology, August 2008, p. 2568-2572, Vol. 46, No. 8
0095-1137/08/$08.00+0     doi:10.1128/JCM.00535-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

In Vitro Survey of Triazole Cross-Resistance among More than 700 Clinical Isolates of Aspergillus Species{triangledown}

M. A. Pfaller,1,2* S. A. Messer,1 L. Boyken,1 C. Rice,1 S. Tendolkar,1 R. J. Hollis,1 and D. J. Diekema1,3

Departments of Pathology,1 Medicine, Roy J. and Lucille A. Carver College of Medicine,3 Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa 522422

Received 19 March 2008/ Returned for modification 4 April 2008/ Accepted 12 June 2008

Few data exist to describe in vitro patterns of cross-resistance among large collections of clinical Aspergillus isolates, including those of species other than Aspergillus fumigatus. We examined 771 Aspergillus spp. clinical isolates collected from 2000 to 2006 as part of a global antifungal surveillance program (553 A. fumigatus, 76 A. flavus, 59 A. niger, 35 A. terreus, and 24 A. versicolor isolates and 24 isolates of other Aspergillus species). Antifungal susceptibility testing was performed by the Clinical and Laboratory Standards Institute (CLSI) M38-A broth dilution method with itraconazole (ITR), posaconazole (POS), ravuconazole (RAV), and voriconazole (VOR). We examined the potential for cross-resistance by using measures of correlation overall and by species. For most Aspergillus isolates (from 88% of isolates for ITR to 98% of isolates for VOR and POS), MICs of each triazole were ≤1 µg/ml. When all 771 isolates were examined, there were statistically significant correlations for all six triazole-triazole pairs. For A. fumigatus, the strongest correlations seen were those between VOR and RAV MICs (r = 0.7) and ITR and POS MICs (r = 0.4). Similarly, for A. flavus, only VOR and RAV MICs and ITR and POS MICs demonstrated statistically significant positive correlations. We have demonstrated correlations among triazole MICs for Aspergillus, which for the most common species (A. fumigatus and A. flavus) were strongest between VOR and RAV MICs and ITR and POS MICs. However, Aspergillus species for which MICs of VOR or POS were >2 µg/ml remain extremely rare (<1% of isolates).

* Corresponding author. Mailing address: Medical Microbiology Division, C606 GH, Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa 52242. Phone: (319) 356-8615. Fax: (319) 356-4916. E-mail: michael-pfaller{at}uiowa.edu

{triangledown} Published ahead of print on 18 June 2008.

Journal of Clinical Microbiology, August 2008, p. 2568-2572, Vol. 46, No. 8
0095-1137/08/$08.00+0     doi:10.1128/JCM.00535-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.



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