Emergence of Aspergillus fumigatus azole resistance in azole-naive patients with chronic obstructive pulmonary disease and their homes
Emergence of Aspergillus fumigatus azole resistance in azole-naive patients with chronic obstructive pulmonary disease and their homes
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DOI：
10.1111/ina.12436
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发表时间：
2018-03-01
期刊：
影响因子：
5.8
通讯作者：
Frealle, E.
中科院分区：
文献类型：
--
作者：
Dauchy, C.;Bautin, N.;Frealle, E.
唑类耐药烟曲霉菌（ARAF）已在慢性阻塞性肺疾病（COPD）患者中报告，但迄今尚未进行专门评估。在这里，我们评估了ARAF在唑类药物初治COPD患者及其家庭中的患病率，并评估了CYP 51 A突变在临床和环境储库中是否相似。前瞻性收集了41例COPD急性加重患者的60份呼吸道样本和36例患者家中的环境样本。A.在41名患者中的11名（27%）和36名患者中的15名（42%）的呼吸道样本中检测到烟曲霉菌。Cyp 51 A测序和伊曲康唑培养基上的临床（n = 68）和环境（n = 48）分离株的选择在11个A中的1个中产生ARAF检测。烟曲霉在COPD患者中占9%，15例中有2例为烟曲霉。烟曲霉菌阳性患者的家中（13%）。临床分离株无CYP 51 A突变。2例患者的2株环境分离株携带TR 34/L98 H突变，1株携带H285 Y突变。在8个呼吸道样本中的3个和10个环境样本中的2个中检测到不同cyp 51 A基因型和/或唑类耐药谱的共存，其中1个以上分离株，证实需要对所有临床相关分离株进行系统筛查。ARAF在COPD患者及其家中的高患病率支持了进一步研究的必要性，以评估北方法国曲霉病患者中唑类耐药的患病率。
Azole-resistant Aspergillus fumigatus (ARAF) has been reported in patients with chronic obstructive pulmonary disease (COPD) but has not been specifically assessed so far. Here, we evaluated ARAF prevalence in azole-naive COPD patients and their homes, and assessed whether CYP51A mutations were similar in clinical and environmental reservoirs. Sixty respiratory samples from 41 COPD patients with acute exacerbation and environmental samples from 36 of these patient's homes were prospectively collected. A. fumigatus was detected in respiratory samples from 11 of 41 patients (27%) and in 15 of 36 domiciles (42%). Cyp51A sequencing and selection on itraconazole medium of clinical (n = 68) and environmental (n = 48) isolates yielded ARAF detection in 1 of 11 A. fumigatus colonized patients with COPD (9%) and 2 of 15 A. fumigatus-positive patient's homes (13%). The clinical isolate had no CYP51A mutation. Two environmental isolates from two patients harbored TR34/L98H mutation, and one had an H285Y mutation. Coexistence of different cyp51A genotypes and/or azole resistance profiles was detected in 3 of 8 respiratory and 2 of 10 environmental samples with more than one isolate, confirming the need for a systematic screening of all clinically relevant isolates. The high prevalence of ARAF in patients with COPD and their homes supports the need for further studies to assess the prevalence of azole resistance in patients with Aspergillus diseases in Northern France.