{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:38:41Z","timestamp":1792510721078,"version":"4.5.0"},"reference-count":18,"publisher":"American Society for Microbiology","issue":"10","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"name":"NIAID\/NIH","award":["U19AI166761"],"award-info":[{"award-number":["U19AI166761"]}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2026,10,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Treatment of symptomatic patients with coccidioidomycosis often involves the use of triazole antifungals. There is concern for reduced susceptibility of\n                      <jats:italic toggle=\"yes\">Coccidioides<\/jats:italic>\n                      to fluconazole, as a high percentage of isolates were previously reported to have elevated fluconazole MICs. We reviewed our recent azole MICs against\n                      <jats:italic toggle=\"yes\">Coccidioides<\/jats:italic>\n                      and examined temporal trends over a 20-year period. Our clinical laboratory database was queried for data against\n                      <jats:italic toggle=\"yes\">Coccidioides<\/jats:italic>\n                      between 2006 and 2025, and trends in GM MICs and the percentage of isolates with elevated MICs to the azoles were assessed. All testing had been performed by broth dilution according to Clinical and Laboratory Standards Institute (CLSI) M38 methods. The results over the 10-year period from 2016 to 2025 were compared to those previously reported by our group from 2001 to 2015. Overall, the results between the two periods showed similar MIC parameters and distributions for fluconazole, itraconazole, posaconazole, and voriconazole, with posaconazole demonstrating the most potent activity, while fluconazole demonstrated reduced susceptibility. Isavuconazole MIC parameters were available during the second period and similar to those of voriconazole. Weak correlations were observed between fluconazole MICs and those of the other azoles. Fluctuations in GM MICs and the percentage of isolates with elevated MICs were observed with fluconazole, itraconazole, and posaconazole, with elevated values observed between 2011 and 2019. Continued surveillance is needed, and outcome data are required to determine if the consistently reduced susceptibility observed with fluconazole or in those infected with strains that have higher MICs results in poorer outcomes in patients with coccidioidomycosis.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/aac.00744-26","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:06:31Z","timestamp":1788444391000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["<i>In vitro<\/i>\n                    activity profiles and temporal trends in reduced susceptibility to azoles in\n                    <i>Coccidioides<\/i>\n                    in the United States"],"prefix":"10.1128","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2225-5122","authenticated-orcid":true,"given":"Nathan P.","family":"Wiederhold","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02f6dcw23","id-type":"ROR","asserted-by":"publisher"}],"name":"Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio","place":["San Antonio, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Bisson","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01an7q238","id-type":"ROR","asserted-by":"publisher"}],"name":"University of California","place":["Berkeley, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Stevens","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00f54p054","id-type":"ROR","asserted-by":"publisher"}],"name":"Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1091-3420","authenticated-orcid":true,"given":"Chiung-Yu","family":"Hung","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01kd65564","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Molecular Microbiology and Immunology, South Texas Center for Emerging Infectious Diseases, University of Texas at San Antonio","place":["San Antonio, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1992-3270","authenticated-orcid":true,"given":"Jose","family":"Lopez-Ribot","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01kd65564","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Molecular Microbiology and Immunology, South Texas Center for Emerging Infectious Diseases, University of Texas at San Antonio","place":["San Antonio, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9513-7127","authenticated-orcid":true,"given":"Thomas F.","family":"Patterson","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02f6dcw23","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Medicine, Division of Infectious Diseases, University of Texas Health Science Center at San Antonio","place":["San Antonio, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George R.","family":"Thompson III","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05t6gpm70","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Internal Medicine, Division of Infectious Diseases and the Department of Medical Microbiology and Immunology, University of California-Davis Medical Center","place":["Sacramento, USA"]},{"name":"University of California Davis Center for Valley Fever","place":["Sacramento, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2021.03.010"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw360"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(21)00191-2"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/mmy\/myy029"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02634-16"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01948-09"},{"key":"e_1_3_3_8_2","volume-title":"Reference method for broth dilution antifungal susceptibility testing of filamentous fungi","author":"CLSI","year":"2017","unstructured":"CLSI. 2017. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi. Clinical and Laboratory Standards Institute, Wayne, Pennsylvania."},{"key":"e_1_3_3_9_2","unstructured":"CDC. 2026. National notifiable diseases surveillance system. Available from: https:\/\/www.cdc.gov\/nndss\/index.html"},{"key":"e_1_3_3_10_2","unstructured":"CDPH. 2026. Provisional valley fever cases in California. Available from: https:\/\/www.cdph.ca.gov\/Programs\/CID\/DCDC\/Pages\/ValleyFeverProvisionalDashboard.aspx"},{"key":"e_1_3_3_11_2","unstructured":"Maricopa County. 2026. Valley fever. Available from: https:\/\/www.maricopa.gov\/5813\/Valley-Fever"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajim.23218"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/EE9.0000000000000254"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03540350054033"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(23)00046-3"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1029\/2019GH000209"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciac882"},{"key":"e_1_3_3_18_2","volume-title":"Principles and procedure for the development of epidemiological cutoff values for antifungal susceptibility testing","author":"CLSI","year":"2016","unstructured":"CLSI. 2016. CLSI guideline M57. In Principles and procedure for the development of epidemiological cutoff values for antifungal susceptibility testing, 1st ed. Clinical and Laboratory Standards Institute, Wayne, PA.","edition":"1"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02416-16"}],"container-title":["Antimicrobial Agents and Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/aac.00744-26","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/aac.00744-26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T14:48:45Z","timestamp":1792507725000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/aac.00744-26"}},"subtitle":[],"editor":[{"given":"Andreas H.","family":"Groll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":18,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10,7]]}},"alternative-id":["10.1128\/aac.00744-26"],"URL":"https:\/\/doi.org\/10.1128\/aac.00744-26","relation":{},"ISSN":["0066-4804","1098-6596"],"issn-type":[{"value":"0066-4804","type":"print"},{"value":"1098-6596","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"assertion":[{"value":"2026-05-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e00744-26"}}