{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T23:23:32Z","timestamp":1791933812137,"version":"4.3.4"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2020,8,20]],"date-time":"2020-08-20T00:00:00Z","timestamp":1597881600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Asklepios Gilead 2014 Hellas"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Acquired azole resistance (AR) in Aspergillus fumigatus emphasizes the importance of the One Health multisectorial approach. The prevalence of azole-resistant A. fumigatus in the environment of Greece is unknown.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Between October 2016 and September 2017, a total of 716 soil samples were collected from 23 provinces and screened for AR using azole-containing agar plates. Recovered isolates were macro-\/microscopically identified and colonies were counted. Azole susceptibility testing of A. fumigatus species complex (SC) isolates was performed (EUCAST E.DEF9.3.1). Azole-resistant A. fumigatus isolates were subjected to confirmatory molecular identification and sequencing of the cyp51A gene.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>No yeasts were recovered, while multiple moulds grew on 695 (97%) samples. Overall, zygomycetes (most non-Mucor genera) grew on 432 (60%) samples, while Aspergillus spp. grew on 500 (70%) [410 (57%) Aspergillus niger SC; 120 (17%) Aspergillus terreus SC; 101 (14%) A. fumigatus SC; 34 (5%) Aspergillus flavus SC]. The mean \u00b1 SD soil load of Aspergillus spp. was 2.23\u205f\u00b1\u205f0.41 log10 cfu\/g (no differences among species). No azole-resistant non-A. fumigatus spp. isolate was detected. Itraconazole, voriconazole, isavuconazole and posaconazole MIC50\/MIC90 (MIC range) of A. fumigatus SC strains were 0.25\/0.5 (0.25 to &amp;gt;8), 0.5\/1 (0.25 to &amp;gt;8), 1\/1 (0.125 to &amp;gt;8) and 0.06\/0.125 (0.06\u20131) mg\/L, respectively. Overall, 1\/500 (0.2%) of Aspergillus isolates, and 1\/101 (1%) of A. fumigatus SC isolates, was pan-azole-resistant (itraconazole, voriconazole, isavuconazole and posaconazole MIC &amp;gt;8, &amp;gt;8, &amp;gt;8 and 1\u2009mg\/L, respectively). The resistant isolate was recovered from organically grown raisin grapes treated with homemade compost and it was an A. fumigatus sensu stricto isolate harbouring the TR46\/Y121F\/T289A mutation. The soil\u2019s load was higher compared with azole-susceptible strains (3.74 versus 2.09 log10 cfu\/g).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This is the first known report of environmental pan-azole-resistant A. fumigatus in Greece. Since data on Greek clinical isolates are lacking, this finding must alarm the systematic local surveillance of AR in medical settings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkaa316","type":"journal-article","created":{"date-parts":[[2020,6,25]],"date-time":"2020-06-25T19:24:05Z","timestamp":1593113045000},"page":"3181-3188","source":"Crossref","is-referenced-by-count":18,"title":["Nationwide surveillance of azole-resistant Aspergillus fumigatus environmental isolates in Greece: detection of pan-azole resistance associated with the TR46\/Y121F\/T289A cyp51A mutation"],"prefix":"10.1093","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5924-1007","authenticated-orcid":false,"given":"Maria","family":"Siopi","sequence":"first","affiliation":[{"name":"Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Rivero-Menendez","sequence":"additional","affiliation":[{"name":"Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Gkotsis","sequence":"additional","affiliation":[{"name":"Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthi","family":"Panara","sequence":"additional","affiliation":[{"name":"Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos S","family":"Thomaidis","sequence":"additional","affiliation":[{"name":"Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8651-4405","authenticated-orcid":false,"given":"Ana","family":"Alastruey-Izquierdo","sequence":"additional","affiliation":[{"name":"Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spyros","family":"Pournaras","sequence":"additional","affiliation":[{"name":"Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8869-1509","authenticated-orcid":false,"given":"Joseph","family":"Meletiadis","sequence":"additional","affiliation":[{"name":"Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,8,20]]},"reference":[{"key":"2020101604552800400_dkaa316-B1","doi-asserted-by":"crossref","first-page":"E57","DOI":"10.3390\/jof3040057","article-title":"Global and multi-national prevalence of fungal diseases-estimate precision","volume":"3","author":"Bongomin","year":"2017","journal-title":"J Fungi"},{"key":"2020101604552800400_dkaa316-B2","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.cmi.2018.01.002","article-title":"Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline","volume":"24","author":"Ullmann","year":"2018","journal-title":"Clin Microbiol Infect"},{"key":"2020101604552800400_dkaa316-B3","volume-title":"Risk Assessment on the Impact of Environmental Usage of Triazoles on the Development and Spread of Resistance to Medical Triazoles in Aspergillus Species","year":"2013"},{"key":"2020101604552800400_dkaa316-B4","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1093\/cid\/ciy859","article-title":"Voriconazole resistance and mortality in invasive aspergillosis: a multicenter retrospective cohort study","volume":"68","author":"Lestrade","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2020101604552800400_dkaa316-B5","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.3389\/fmicb.2016.01382","article-title":"Epidemiological and genomic landscape of azole resistance mechanisms in Aspergillus fungi","volume":"7","author":"Hagiwara","year":"2016","journal-title":"Front Microbiol"},{"key":"2020101604552800400_dkaa316-B6","doi-asserted-by":"crossref","first-page":"20170635","DOI":"10.1098\/rspb.2017.0635","article-title":"Evolution of cross-resistance to medical triazoles in Aspergillus fumigatus through selection pressure of environmental fungicides","volume":"284","author":"Zhang","year":"2017","journal-title":"Proc R Soc B Biol Sci"},{"key":"2020101604552800400_dkaa316-B7","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.jhazmat.2016.12.013","article-title":"Fungicides induced triazole-resistance in Aspergillus fumigatus associated with mutations of TR46\/Y121F\/T289A and its appearance in agricultural fields","volume":"326","author":"Ren","year":"2017","journal-title":"J Hazard Mater"},{"key":"2020101604552800400_dkaa316-B8","doi-asserted-by":"crossref","first-page":"e0039219","DOI":"10.1128\/mBio.00392-19","article-title":"Nonrandom distribution of azole resistance across the global population of Aspergillus fumigatus","volume":"10","author":"Sewell","year":"2019","journal-title":"MBio"},{"key":"2020101604552800400_dkaa316-B9","doi-asserted-by":"crossref","first-page":"E21","DOI":"10.3390\/jof2030021","article-title":"Triazole resistance in Aspergillus spp.: a worldwide problem?","volume":"2","author":"Rivero-Menendez","year":"2016","journal-title":"J Fungi"},{"key":"2020101604552800400_dkaa316-B10","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.3201\/eid2507.181625","article-title":"Environmental hotspots for azole resistance selection of Aspergillus fumigatus, the Netherlands","volume":"25","author":"Schoustra","year":"2019","journal-title":"Emerg Infect Dis"},{"key":"2020101604552800400_dkaa316-B11","doi-asserted-by":"crossref","first-page":"4053","DOI":"10.1128\/AEM.00231-09","article-title":"Possible environmental origin of resistance of Aspergillus fumigatus to medical triazoles","volume":"75","author":"Snelders","year":"2009","journal-title":"Appl Environ Microbiol"},{"key":"2020101604552800400_dkaa316-B12","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.cmi.2018.09.008","article-title":"How to: EUCAST recommendations on the screening procedure E.Def 10.1 for the detection of azole resistance in Aspergillus fumigatus isolates using four-well azole-containing agar plates","volume":"25","author":"Guinea","year":"2019","journal-title":"Clin Microbiol Infect"},{"key":"2020101604552800400_dkaa316-B13","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1128\/AAC.03850-14","article-title":"Posaconazole prophylaxis in experimental azole-resistant invasive pulmonary aspergillosis","volume":"59","author":"Seyedmousavi","year":"2015","journal-title":"Antimicrob Agents Chemother"},{"key":"2020101604552800400_dkaa316-B14","author":"De Hoog","year":"2001"},{"key":"2020101604552800400_dkaa316-B15","author":"Arendrup","year":"2017"},{"key":"2020101604552800400_dkaa316-B16","doi-asserted-by":"crossref","first-page":"3380","DOI":"10.1128\/AAC.00383-13","article-title":"Population-based survey of filamentous fungi and antifungal resistance in Spain (FILPOP Study)","volume":"57","author":"Alastruey-Izquierdo","year":"2013","journal-title":"Antimicrob Agents Chemother"},{"key":"2020101604552800400_dkaa316-B17","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1128\/AAC.01092-06","article-title":"A new Aspergillus fumigatus resistance mechanism conferring in vitro cross-resistance to azole antifungals involves a combination of cyp51A alterations","volume":"51","author":"Mellado","year":"2007","journal-title":"Antimicrob Agents Chemother"},{"key":"2020101604552800400_dkaa316-B18","doi-asserted-by":"crossref","first-page":"81","DOI":"10.3201\/eid2601.190885","article-title":"High azole resistance in Aspergillus fumigatus isolates from strawberry fields, China, 2018","volume":"26","author":"Chen","year":"2020","journal-title":"Emerg Infect Dis"},{"key":"2020101604552800400_dkaa316-B19","doi-asserted-by":"crossref","first-page":"121712","DOI":"10.1016\/j.jhazmat.2019.121712","article-title":"Wide-scope target screening of &gt;2000 emerging contaminants in wastewater samples with UPLC-Q-ToF-HRMS\/MS and smart evaluation of its performance through the validation of 195 selected representative analytes","volume":"387","author":"Gago-Ferrero","year":"2020","journal-title":"J Hazard Mater"},{"key":"2020101604552800400_dkaa316-B20","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1128\/JCM.02478-15","article-title":"First detection of TR34\/L98H and TR46\/Y121F\/T289A Cyp51 mutations in Aspergillus fumigatus isolates in the United States","volume":"54","author":"Wiederhold","year":"2016","journal-title":"J Clin Microbiol"},{"key":"2020101604552800400_dkaa316-B21","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.jgar.2018.10.017","article-title":"Azole-resistant Aspergillus fumigatus in the Italian environment","volume":"16","author":"Prigitano","year":"2019","journal-title":"J Glob Antimicrob Resist"},{"key":"2020101604552800400_dkaa316-B22","doi-asserted-by":"crossref","first-page":"E131","DOI":"10.3390\/jof4040131","article-title":"Environmental isolates of multi-azole-resistant Aspergillus spp. in Southern Italy","volume":"4","author":"Trovato","year":"2018","journal-title":"J Fungi"},{"key":"2020101604552800400_dkaa316-B23","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.3389\/fmicb.2018.01395","article-title":"Determination of the prevalence of triazole resistance in environmental Aspergillus fumigatus strains isolated in South Wales, UK","volume":"9","author":"Tsitsopoulou","year":"2018","journal-title":"Front Microbiol"},{"key":"2020101604552800400_dkaa316-B24","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1128\/AAC.00073-19","article-title":"EUCAST susceptibility testing of isavuconazole: MIC data for contemporary clinical mold and yeast isolates","volume":"63","author":"J\u00f8rgensen","year":"2019","journal-title":"Antimicrob Agents Chemother"},{"key":"2020101604552800400_dkaa316-B25","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.3201\/eid1507.090043","article-title":"Frequency and evolution of azole resistance in Aspergillus fumigatus associated with treatment failure","volume":"15","author":"Howard","year":"2009","journal-title":"Emerg Infect Dis"},{"key":"2020101604552800400_dkaa316-B26","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.jgar.2014.05.004","article-title":"Occurrence of azole-resistant species of Aspergillus in the UK environment","volume":"2","author":"Bromley","year":"2014","journal-title":"J Glob Antimicrob Resist"},{"key":"2020101604552800400_dkaa316-B27","doi-asserted-by":"crossref","first-page":"4545","DOI":"10.1128\/AAC.00692-10","article-title":"Environmental study of azole-resistant Aspergillus fumigatus and other aspergilli in Austria, Denmark, and Spain","volume":"54","author":"Mortensen","year":"2010","journal-title":"Antimicrob Agents Chemother"},{"key":"2020101604552800400_dkaa316-B28","doi-asserted-by":"crossref","first-page":"5581","DOI":"10.1007\/s10661-014-3804-8","article-title":"Does fungicide application in vineyards induce resistance to medical azoles in Aspergillus species?","volume":"186","author":"Lago","year":"2014","journal-title":"Environ Monit Assess"},{"key":"2020101604552800400_dkaa316-B29","doi-asserted-by":"crossref","first-page":"e219","DOI":"10.1371\/journal.pmed.0050219","article-title":"Emergence of azole resistance in Aspergillus fumigatus and spread of a single resistance mechanism","volume":"5","author":"Snelders","year":"2008","journal-title":"PLoS Med"},{"key":"2020101604552800400_dkaa316-B30","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1093\/cid\/cit320","article-title":"Aspergillosis due to voriconazole highly-resistant Aspergillus fumigatus and recovery of genetically related resistant isolates from domestic homes","volume":"57","author":"van der Linden","year":"2013","journal-title":"Clin Infect Dis"},{"key":"2020101604552800400_dkaa316-B31","year":"2019"},{"key":"2020101604552800400_dkaa316-B32","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1002\/ps.3664","article-title":"Assessment of selection and resistance risk for demethylation inhibitor fungicides in Aspergillus\u2009fumigatus in agriculture and medicine: a critical review","volume":"70","author":"Gisi","year":"2014","journal-title":"Pest Manag Sci"},{"key":"2020101604552800400_dkaa316-B33","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1111\/j.1365-3059.2011.02439.x","article-title":"The dose rate debate: does the risk of fungicide resistance increase or decrease with dose?","volume":"60","author":"van den Bosch","year":"2011","journal-title":"Plant Pathol"},{"key":"2020101604552800400_dkaa316-B34","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.3201\/eid2106.140717","article-title":"Prospective multicenter international surveillance of azole resistance in Aspergillus fumigatus","volume":"21","author":"van der Linden","year":"2015","journal-title":"Emerg Infect Dis"},{"key":"2020101604552800400_dkaa316-B35","doi-asserted-by":"crossref","first-page":"516","DOI":"10.3389\/fmicb.2018.00516","article-title":"Azole-resistance in Aspergillus terreus and related species: an emerging problem or a rare phenomenon?","volume":"9","author":"Zoran","year":"2018","journal-title":"Front Microbiol"},{"key":"2020101604552800400_dkaa316-B36","doi-asserted-by":"crossref","first-page":"3025","DOI":"10.1128\/AAC.01491-10","article-title":"Polyphasic identification and susceptibility to seven antifungals of 102 Aspergillus isolates recovered from immunocompromised hosts in Greece","volume":"55","author":"Arabatzis","year":"2011","journal-title":"Antimicrob Agents Chemother"}],"container-title":["Journal of Antimicrobial Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jac\/article-pdf\/75\/11\/3181\/33893157\/dkaa316.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jac\/article-pdf\/75\/11\/3181\/33893157\/dkaa316.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,10,16]],"date-time":"2020-10-16T08:57:21Z","timestamp":1602838641000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jac\/article\/75\/11\/3181\/5894665"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,20]]},"references-count":36,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,8,20]]},"published-print":{"date-parts":[[2020,11,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jac\/dkaa316","relation":{},"ISSN":["0305-7453","1460-2091"],"issn-type":[{"value":"0305-7453","type":"print"},{"value":"1460-2091","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,11]]},"published":{"date-parts":[[2020,8,20]]}}}