{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T03:02:00Z","timestamp":1790823720848,"version":"4.1.0"},"reference-count":45,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n \n Accurate species identification and antifungal susceptibility testing are essential for effective aspergillosis treatment. However, non\n \u2013Aspergillus fumigatus<\/jats:italic>\n species, such as\n Aspergillus tubingensis<\/jats:italic>\n , are often misidentified and understudied, potentially compromising proper prognosis and treatment.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n To examine the species and prevalence of triazole resistance among clinical\n Aspergillus<\/jats:italic>\n isolates in Southern California.\n <\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n \n This cross-sectional study collected clinical\n Aspergillus<\/jats:italic>\n cultures from September 1, 2019, to June 30, 2023, at Kaiser Permanente Southern California, an integrated health system serving a diverse regional population. Triazole susceptibility testing and whole genome sequencing were performed on selected isolates. A total of 2421 consecutive\n Aspergillus<\/jats:italic>\n cultures were included. Eighty putative\n Aspergillus niger<\/jats:italic>\n isolates were selected for sequencing, including 44 with positive growth in the presence of at least one clinically relevant triazole.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n The primary outcome was the genome-based species identification of\n A tubingensis<\/jats:italic>\n . The secondary outcome was triazole susceptibility above the\n A niger<\/jats:italic>\n epidemiological cut-off values. The hypothesis that\n A tubingensis<\/jats:italic>\n is a prevalent, underrecognized, triazole-resistant pathogen was developed during data collection.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 2421 cultures, 1835 were successfully cultured for\n Aspergillus<\/jats:italic>\n . After purification and deduplication, 1505 isolates were screened for triazole resistance. A substantial fraction of putative\n A niger<\/jats:italic>\n isolates grew at the\n A niger<\/jats:italic>\n epidemiological cut-off for itraconazole (110 of 664 [15.1%]). DNA sequencing revealed that 59 of 80 putative\n A niger<\/jats:italic>\n isolates (73.8%) were actually\n A tubingensis<\/jats:italic>\n . Elevated triazole minimum inhibitory concentrations were not strongly associated with any known\n cyp51<\/jats:italic>\n mutations among the\n A tubingensis<\/jats:italic>\n isolates.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n \n In this cross-sectional study of\n Aspergillus<\/jats:italic>\n isolates from Kaiser Permanente Southern California,\n A tubingensis<\/jats:italic>\n was a prevalent but underrecognized cause of aspergillosis in Southern California. Its frequent misidentification, association with invasive infections, and triazole resistance underscore the need for improved diagnostics and species-specific epidemiological investigations.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.43630","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T16:30:46Z","timestamp":1764865846000},"page":"e2543630","source":"Crossref","is-referenced-by-count":9,"title":["Triazole Resistance and Misidentification of\n Aspergillus tubingensis<\/i>\n in Southern California"],"prefix":"10.1001","volume":"8","author":[{"given":"Yashan","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Environmental and Occupational Health, Antibiotic Resistance Action Center, The George Washington University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maliha","family":"Aziz","sequence":"additional","affiliation":[{"name":"Department of Environmental and 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Pasadena"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Quinlivan","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health, Antibiotic Resistance Action Center, The George Washington University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Rayens","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason W.","family":"Sahl","sequence":"additional","affiliation":[{"name":"Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"June","family":"Sass","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health, Antibiotic Resistance Action Center, The George Washington University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Skela","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Sung","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health, Antibiotic Resistance Action Center, The George Washington University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Villani","sequence":"additional","affiliation":[{"name":"Department of Global Health, The George Washington University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New 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