Timely and effective antifungal therapy is essential for aspergillosis. This multicenter surveillance study provides comprehensive insights into the species distribution and antifungal susceptibility of 550 clinical Aspergillus isolates in Taiwan, with intrinsic reduced susceptibility to amphotericin B, itraconazole, or isavuconazole noted in certain species. Regarding acquired resistance, a novel cyp51A mutation, P214L, was identified in an azole-resistant Aspergillus flavus, orthologous to Aspergillus fumigatus P216L. Recovery of azole-resistant A. fumigatus harboring TR34/L98H or TR46/Y121F/T289A mutations remains a concern and emphasizes the need for antifungal stewardship in the environment. Novel antifungals, including orolofim, manogepix, rezafungin, and ibrexafungerp, demonstrated broad activity across Aspergillus species, including resistant isolates. Nevertheless, the inhaled agent opelconazole exhibited limited activity against A. flavus regardless of voriconazole susceptibility and against other species showing reduced susceptibility to itraconazole. These findings highlight the importance of species-level identification, susceptibility testing, and continued surveillance and support the use of novel antifungals for aspergillosis.
Hsieh et al. (Tue,) studied this question.