PCR ‐based detection of Aspergillus fumigatus and absence of azole resistance due to TR 34/L98H in a french multicenter cohort of 137 patients with fungal rhinosinusitis

Summary Fungal rhinosinusitis (FRS) has a worldwide distribution, comprises distinct clinical entities but is mostly due to Aspergillus among which Aspergillus fumigatus plays a major role in European countries. Although, there is accumulating evidence for the emergence of environmentally acquired‐azole resistance in A. fumigatus (such as TR34/L98H) in various clinical settings, there is few data for patients with FRS. In this study, we aimed to investigate the prevalence of A. fumigatus azole resistance due to TR34/L98H in a multicentre cohort of patients with FRS. One hundred and thirty‐seven patients with FRS admitted between 2002 and 2016 at four French medical centres were retrospectively enrolled. Clinical and mycological findings were collected. Aspergillus fumigatus and the TR34/L98H alteration conferring azole resistance were investigated directly from clinical samples using the commercial CE‐IVD marked MycoGENIE® A. fumigatus real‐time PCR assay. Fungal ball was the more frequent clinical form (n = 118). Despite the presence of fungal hyphae at direct microscopic examination, mycological cultures remained negative for 83 out of the 137 patients (60.6%). The PCR assay proved to be useful allowing the identification of A. fumigatus and etiological diagnosis in 106 patients (77.4%) compared with 44 patients (32.1%) when using culture as the reference method. Importantly, neither TR34 nor L98H alterations were evidenced.