Epidemiology and mechanisms of antifungal resistance in Aspergillus : а review

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Abstract

Invasive mycoses have become an increasingly serious global public health concern, particularly in immunocompromised patients. Species of the genus Aspergillus—most notably Aspergillus fumigatus—are among the principal causative pathogens. Despite advances in antifungal therapy, especially azole-based agents, the spread of azole-resistant Aspergillus spp. is emerging as a major clinical threat.

This review summarizes current data on the prevalence of drug-resistant Aspergillus spp. and describes the resistance mechanisms identified to date. The primary focus is on publications from the last decade; however, key foundational studies from earlier periods were also considered. The scientific data search was performed in eLIBRARY.RU, PubMed, Google Scholar, and Wally.

The analysis demonstrated a substantial increase in invasive aspergillosis cases caused by resistant Aspergillus strains. The main mechanisms of resistance include mutations in the cyp51 gene and hyperactivation of efflux transport proteins. Resistant isolates have been reported in Europe, Asia, Africa, and the Americas.

These findings may be used to inform guidelines aimed at improving epidemiologic surveillance of antifungal resistance in Aspergillus. Priority areas for future research should include development of antifungal agents, improved diagnostic assays for rapid detection of resistant strains, and optimization of treatment regimens. There is an urgent need for greater clinician awareness regarding the risks associated with azole use and tighter antifungal resistance control measures.

About the authors

Anastasia V. Avtonomova

Research Institute for the Search of New Antibiotics named after G.F. Gause

Author for correspondence.
Email: nomova@yandex.ru
ORCID iD: 0000-0001-5098-5379
SPIN-code: 4409-8108

Cand. Sci. (Biology)

Russian Federation, Moscow

Olga V. Kisil

Research Institute for the Search of New Antibiotics named after G.F. Gause

Email: olvv@mail.ru
ORCID iD: 0000-0003-4799-1318
SPIN-code: 1153-8414

Cand. Sci. (Chemistry)

Russian Federation, Moscow

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