Cryptic species of Aspergillus fumigatus, including the Aspergillus viridinutans species complex, are increasingly reported to be causes of invasive aspergillosis. Their identification is clinically relevant, as these species frequently have intrinsic resistance to common antifungals. We evaluated the susceptibilities of 90 environmental and clinical isolates from the A. viridinutans species complex, identified by DNA sequencing of the calmodulin gene, to seven antifungals (voriconazole, posaconazole, itraconazole, amphotericin B, anidulafungin, micafungin, and caspofungin) using the reference European Committee on Antimicrobial Susceptibility Testing (EUCAST) method. The majority of species demonstrated elevated MICs of voriconazole (geometric mean [GM] MIC, 4.46 mg/liter) and itraconazole (GM MIC, 9.85 mg/liter) and had variable susceptibility to amphotericin B (GM MIC, 2.5 mg/liter). Overall, the MICs of posaconazole and the minimum effective concentrations of echinocandins were low. The results obtained by the EUCAST method were compared with the results obtained with Sensititre YeastOne (YO) panels. Overall, there was 67% agreement (95% confidence interval [CI], 62 to 72%) between the results obtained by the EUCAST method and those obtained with YO panels when the results were read at 48 h and 82% agreement (95% CI, 78 to 86%) when the results were read at 72 h. There was a significant difference in agreement between antifungals; agreement was high for amphotericin B, voriconazole, and posaconazole (70 to 86% at 48 h and 88 to 93% at 72 h) but was very low for itraconazole (37% at 48 h and 57% at 72 h). The agreement was also variable between species, with the maximum agreement being observed for A. felis isolates (85 and 93% at 48 and 72 h, respectively). Elevated MICs of voriconazole and itraconazole were cross-correlated, but there was no correlation between the other azoles tested.

Department of Botany Faculty of Science Charles University Prague Czech Republic

Department of Microbiology Faculty of Medicine and Dentistry Palacky University Olomouc Czech Republic

Department of Nutrition Science University of Nagasaki Nagasaki Japan

Laboratory of Clinical Mycology Institute of Public Health Ostrava Czech Republic

Laboratory of Fungal Genetics and Metabolism Institute of Microbiology of the CAS Prague Czech Republic

Laboratory of Medical Mycology Department of Parasitology Mycology and Mycobacteriology Prague Public Health Institute in Usti nad Labem Prague Czech Republic

Medical Mycology Research Center Chiba University Chiba Japan

Sydney School of Veterinary Science and Marie Bashir Institute of Infectious Diseases and Biosecurity University of Sydney Camperdown New South Wales Australia

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Current and Future Pathways in Aspergillus Diagnosis

Unravelling species boundaries in the Aspergillus viridinutans complex (section Fumigati): opportunistic human and animal pathogens capable of interspecific hybridization