{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T03:29:48Z","timestamp":1785814188818,"version":"3.56.0"},"reference-count":61,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T00:00:00Z","timestamp":1665964800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004160","name":"Mazandaran University of Medical Sciences","doi-asserted-by":"publisher","award":["7148"],"award-info":[{"award-number":["7148"]}],"id":[{"id":"10.13039\/501100004160","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Invasive aspergillosis is one of the most common fungal infections and azole resistance in <jats:italic>Aspergillus fumigatus<\/jats:italic> (ARA<jats:italic>f<\/jats:italic>) is a growing medical concern in high\u2010risk patients. To our knowledge, there is no comprehensive epidemiological surveillance study on the prevalence and incidence of ARA<jats:italic>f<\/jats:italic> isolates available in Iran.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The study aimed to report a five\u2010year survey of triazole phenotypes and genotype patterns concerning the resistance in clinical and environmental <jats:italic>A.\u00a0fumigatus<\/jats:italic> in Iran.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>During the study time frame (2016\u20132021), a total of 1208 clinical and environmental <jats:italic>Aspergillus<\/jats:italic> species were collected. Isolates were examined and characterised by in vitro antifungal susceptibility testing (CLSI M38 broth microdilution) and <jats:italic>cyp<\/jats:italic>51A sequencing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 485 <jats:italic>Aspergillus<\/jats:italic> section <jats:italic>Fumigati<\/jats:italic> strains were recovered (clinical, <jats:italic>n<\/jats:italic>\u00a0=\u00a023; 4.74% and environment, <jats:italic>n<\/jats:italic>\u00a0=\u00a0462; 95.26%). Of which <jats:italic>A.\u00a0fumigatus<\/jats:italic> isolates were the most prevalent species (<jats:italic>n<\/jats:italic>\u00a0=\u00a0483; 99.59%). Amphotericin B and the echinocandins demonstrated good in vitro activity against the majority of isolates in comparison to triazole. Overall, 16.15% (<jats:italic>n<\/jats:italic>\u00a0=\u00a078) of isolates were phenotypically resistant to at least one of the azoles. However, 9.73% of <jats:italic>A.\u00a0fumigatus<\/jats:italic> isolates for voriconazole were classified as resistant, 89.03% were susceptible, and 1.24% were intermediate. While, for itraconazole and posaconazole, using the epidemiological cut\u2010off value 16.15% and 6.83% of isolates were non\u2010wild types, respectively. Remarkably, in 21.79% (<jats:italic>n<\/jats:italic>\u00a0=\u00a017) phenotypically resistant isolates, no mutations were detected within the cyp51A gene.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Although the incidence of ARA<jats:italic>f<\/jats:italic> varies from country to country, in Iran the rate has ranged from 3.3% to 18%, significantly increasing from 2013 to 2021. Strikingly, a quarter of the phenotypically resistant isolates harboured no mutations in the <jats:italic>cyp<\/jats:italic>51A gene. It seems that other mechanisms of resistance are importantly increasing. To fill a gap in our understanding of the mechanism for azole resistance in the non\u2010<jats:italic>cyp51A<\/jats:italic> strains, we highly recommend further and more extensive monitoring of the soil with or without exposure to fungicides in agricultural and hospital areas.<\/jats:p><\/jats:sec>","DOI":"10.1111\/myc.13535","type":"journal-article","created":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T06:39:46Z","timestamp":1664951986000},"page":"98-105","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Five\u2010year surveillance study of clinical and environmental <scp>Triazole\u2010Resistant<\/scp><i>Aspergillus fumigatus<\/i> isolates in Iran"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1151-9265","authenticated-orcid":false,"given":"Shaghayegh","family":"Khojasteh","sequence":"first","affiliation":[{"name":"Department of Medical Mycology, School of Medicine Mazandaran University of Medical Sciences  Sari Iran"},{"name":"Invasive Fungi Research Center, Communicable Diseases Institute Mazandaran University of Medical Sciences  Sari Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0016-2849","authenticated-orcid":false,"given":"Mahdi","family":"Abastabar","sequence":"additional","affiliation":[{"name":"Department of Medical Mycology, School of Medicine Mazandaran University of Medical Sciences  Sari Iran"},{"name":"Invasive Fungi Research Center, Communicable Diseases Institute Mazandaran University of Medical Sciences  Sari Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9723-7618","authenticated-orcid":false,"given":"Iman","family":"Haghani","sequence":"additional","affiliation":[{"name":"Department of Medical Mycology, School of Medicine Mazandaran University of Medical Sciences  Sari Iran"},{"name":"Invasive Fungi Research Center, 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