{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:18:31Z","timestamp":1791389911052,"version":"4.3.3"},"reference-count":83,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T00:00:00Z","timestamp":1627516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005825","name":"National Institute of Food and Agriculture","doi-asserted-by":"publisher","award":["GRANT12683805"],"award-info":[{"award-number":["GRANT12683805"]}],"id":[{"id":"10.13039\/100005825","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005825","name":"National Institute of Food and Agriculture","doi-asserted-by":"publisher","award":["GRANT12683805"],"award-info":[{"award-number":["GRANT12683805"]}],"id":[{"id":"10.13039\/100005825","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plospathogens.org"],"crossmark-restriction":false},"short-container-title":["PLoS Pathog"],"abstract":"<jats:p><jats:italic>Aspergillus fumigatus<\/jats:italic> is an opportunistic human pathogen that causes aspergillosis, a spectrum of environmentally acquired respiratory illnesses. It has a cosmopolitan distribution and exists in the environment as a saprotroph on decaying plant matter. Azoles, which target Cyp51A in the ergosterol synthesis pathway, are the primary class of drugs used to treat aspergillosis. Azoles are also used to combat plant pathogenic fungi. Recently, an increasing number of azole-naive patients have presented with pan-azole\u2013resistant strains of <jats:italic>A<\/jats:italic>. <jats:italic>fumigatus<\/jats:italic>. The TR<jats:sub>34<\/jats:sub>\/L98H and TR<jats:sub>46<\/jats:sub>\/Y121F\/T289A alleles in the <jats:italic>cyp51A<\/jats:italic> gene are the most common ones conferring pan-azole resistance. There is evidence that these mutations arose in agricultural settings; therefore, numerous studies have been conducted to identify azole resistance in environmental <jats:italic>A<\/jats:italic>. <jats:italic>fumigatus<\/jats:italic> and to determine where resistance is developing in the environment. Here, we summarize the global occurrence of azole-resistant <jats:italic>A<\/jats:italic>. <jats:italic>fumigatus<\/jats:italic> in the environment based on available literature. Additionally, we have created an interactive world map showing where resistant isolates have been detected and include information on the specific alleles identified, environmental settings, and azole fungicide use. Azole-resistant <jats:italic>A<\/jats:italic>. <jats:italic>fumigatus<\/jats:italic> has been found on every continent, except for Antarctica, with the highest number of reports from Europe. Developed environments, specifically hospitals and gardens, were the most common settings where azole-resistant <jats:italic>A<\/jats:italic>. <jats:italic>fumigatus<\/jats:italic> was detected, followed by soils sampled from agricultural settings. The TR<jats:sub>34<\/jats:sub>\/L98H resistance allele was the most common in all regions except South America where the TR<jats:sub>46<\/jats:sub>\/Y121F\/T289A allele was the most common. A major consideration in interpreting this survey of the literature is sampling bias; regions and environments that have been extensively sampled are more likely to show greater azole resistance even though resistance could be more prevalent in areas that are under-sampled or not sampled at all. Increased surveillance to pinpoint reservoirs, as well as antifungal stewardship, is needed to preserve this class of antifungals for crop protection and human health.<\/jats:p>","DOI":"10.1371\/journal.ppat.1009711","type":"journal-article","created":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T18:22:31Z","timestamp":1627582951000},"page":"e1009711","update-policy":"https:\/\/doi.org\/10.1371\/journal.ppat.corrections_policy","source":"Crossref","is-referenced-by-count":166,"title":["Azole-resistant Aspergillus fumigatus in the environment: Identifying key reservoirs and hotspots of antifungal resistance"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9751-2904","authenticated-orcid":true,"given":"Caroline","family":"Burks","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9083-8197","authenticated-orcid":true,"given":"Alexandria","family":"Darby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7643-7634","authenticated-orcid":true,"given":"Luisa","family":"G\u00f3mez Londo\u00f1o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7110-063X","authenticated-orcid":true,"given":"Michelle","family":"Momany","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7064-6021","authenticated-orcid":true,"given":"Marin T.","family":"Brewer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,7,29]]},"reference":[{"issue":"4","key":"ppat.1009711.ref001","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1086\/513943","article-title":"Invasive aspergillosis.","volume":"26","author":"DW Denning","year":"1998","journal-title":"Clin Infect Dis"},{"issue":"2","key":"ppat.1009711.ref002","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1128\/CMR.12.2.310","article-title":"Aspergillus fumigatus and aspergillosis","volume":"12","author":"J-P Latg\u00e9","year":"1999","journal-title":"Clin Microbiol Rev"},{"issue":"3","key":"ppat.1009711.ref003","doi-asserted-by":"crossref","first-page":"55","DOI":"10.3390\/jof5030055","article-title":"Invasive aspergillosis by Aspergillus flavus: Epidemiology, diagnosis, antifungal resistance, and management.","volume":"5","author":"SM Rudramurthy","year":"2019","journal-title":"J Fungi (Basel)."},{"issue":"1","key":"ppat.1009711.ref004","article-title":"Aspergillus fumigatus and aspergillosis in 2019","volume":"33","author":"J-P Latg\u00e9","year":"2019","journal-title":"Clin Microbiol Rev"},{"issue":"4","key":"ppat.1009711.ref005","doi-asserted-by":"crossref","first-page":"57","DOI":"10.3390\/jof3040057","article-title":"Global and multi-national prevalence of fungal diseases\u2014estimate precision.","volume":"3","author":"F Bongomin","year":"2017","journal-title":"J Fungi (Basel)."},{"key":"ppat.1009711.ref006","doi-asserted-by":"crossref","first-page":"ofw268","DOI":"10.1093\/ofid\/ofw268","article-title":"Trends in hospitalizations related to invasive aspergillosis and mucormycosis in the United States, 2000\u20132013.","author":"S Vallabhaneni","year":"2017","journal-title":"Open Forum Infect Dis."},{"issue":"6","key":"ppat.1009711.ref007","doi-asserted-by":"crossref","first-page":"1524","DOI":"10.1086\/317487","article-title":"Burden of aspergillosis-related hospitalizations in the United States","volume":"31","author":"Erik G. Steven","year":"2000","journal-title":"Clin Infect Dis"},{"issue":"5","key":"ppat.1009711.ref008","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1093\/cid\/ciy181","article-title":"Epidemiology and outcomes of hospitalizations with invasive aspergillosis in the United States, 2009\u20132013","volume":"67","author":"MD Zilberberg","year":"2018","journal-title":"Clin Infect Dis"},{"issue":"4","key":"ppat.1009711.ref009","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.3201\/eid2704.204895","article-title":"Covid-19\u2013associated pulmonary aspergillosis, March\u2013August 2020","volume":"27","author":"J Salmanton-Garc\u00eda","year":"2021","journal-title":"Emerg Infect Dis"},{"issue":"1709","key":"ppat.1009711.ref010","doi-asserted-by":"crossref","first-page":"20150460","DOI":"10.1098\/rstb.2015.0460","article-title":"Clinical implications of globally emerging azole resistance in Aspergillus fumigatus","volume":"371","author":"JF Meis","year":"2016","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"issue":"3","key":"ppat.1009711.ref011","doi-asserted-by":"crossref","first-page":"98","DOI":"10.3390\/jof4030098","article-title":"Treatment of aspergillosis.","volume":"4","author":"J Jenks","year":"2018","journal-title":"J Fungi (Basel)."},{"issue":"2","key":"ppat.1009711.ref012","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1128\/AAC.40.2.279","article-title":"Antifungal agents: Chemotherapeutic targets and immunologic strategies","volume":"40","author":"NH Georgopapadakou","year":"1996","journal-title":"Antimicrob Agents Chemother"},{"issue":"26","key":"ppat.1009711.ref013","doi-asserted-by":"crossref","first-page":"6198","DOI":"10.1021\/jf4013949","article-title":"Typical azole biocides in biosolid-amended soils and plants following biosolid applications","volume":"61","author":"Z-F Chen","year":"2013","journal-title":"J Agric Food Chem"},{"key":"ppat.1009711.ref014","doi-asserted-by":"crossref","first-page":"7463","DOI":"10.1021\/acs.jafc.5b02728","article-title":"Genesis of azole antifungal resistance from agriculture to clinical settings","volume":"63","author":"M-M Azevedo","year":"2015","journal-title":"J Agric Food Chem"},{"key":"ppat.1009711.ref015","author":"U.S. Geological Survey","year":"2018","journal-title":"Estimated annual agricultural pesticide use"},{"issue":"11","key":"ppat.1009711.ref016","doi-asserted-by":"crossref","first-page":"2987","DOI":"10.1128\/AAC.45.11.2987-2990.2001","article-title":"Critical annotations to the use of azole antifungals for plant protection","volume":"45","author":"H. Hof","year":"2001","journal-title":"Antimicrob Agents Chemother"},{"issue":"6","key":"ppat.1009711.ref017","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1128\/AAC.41.6.1364","article-title":"Itraconazole resistance in Aspergillus fumigatus","volume":"41","author":"DW Denning","year":"1997","journal-title":"Antimicrob Agents Chemother"},{"issue":"1","key":"ppat.1009711.ref018","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1128\/AAC.05088-11","article-title":"Rapid induction of multiple resistance mechanisms in Aspergillus fumigatus during azole therapy: A case study and review of the literature","volume":"56","author":"SMT Camps","year":"2012","journal-title":"Antimicrob Agents Chemother"},{"issue":"suppl_1","key":"ppat.1009711.ref019","doi-asserted-by":"crossref","first-page":"S83","DOI":"10.1093\/mmy\/myx144","article-title":"Triazole resistance surveillance in Aspergillus fumigatus","volume":"56","author":"A Resendiz Sharpe","year":"2018","journal-title":"Med Mycol"},{"issue":"7","key":"ppat.1009711.ref020","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":"SJ Howard","year":"2009","journal-title":"Emerg Infect Dis"},{"issue":"14","key":"ppat.1009711.ref021","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1056\/NEJMc061720","article-title":"Multiple-triazole\u2013resistant aspergillosis.","volume":"356","author":"PE Verweij","year":"2007","journal-title":"N Engl J Med"},{"issue":"11","key":"ppat.1009711.ref022","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1016\/j.fgb.2011.08.002","article-title":"The structure\u2013function relationship of the Aspergillus fumigatus cyp51A L98H conversion by site-directed mutagenesis: The mechanism of L98H azole resistance","volume":"48","author":"E Snelders","year":"2011","journal-title":"Fungal Genet Biol"},{"issue":"11","key":"ppat.1009711.ref023","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":"E Snelders","year":"2008","journal-title":"PLoS Med."},{"issue":"s1","key":"ppat.1009711.ref024","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1080\/13693780500090826","article-title":"Azole and fungicide resistance in clinical and environmental Aspergillus fumigatus isolates","volume":"43","author":"I Meneau","year":"2005","journal-title":"Med Mycol"},{"issue":"7","key":"ppat.1009711.ref025","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1038\/nrmicro1179","article-title":"Evolution of antifungal-drug resistance: Mechanisms and pathogen fitness","volume":"3","author":"JB Anderson","year":"2005","journal-title":"Nat Rev Microbiol"},{"issue":"3","key":"ppat.1009711.ref026","doi-asserted-by":"crossref","first-page":"e31801","DOI":"10.1371\/journal.pone.0031801","article-title":"Triazole fungicides can induce cross-resistance to medical triazoles in Aspergillus fumigatus.","volume":"7","author":"E Snelders","year":"2012","journal-title":"PLoS ONE"},{"issue":"12","key":"ppat.1009711.ref027","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":"RAG Snelders E. Huis In \u2019T Veld","year":"2009","journal-title":"Appl Environ Microbiol"},{"issue":"3","key":"ppat.1009711.ref028","doi-asserted-by":"crossref","DOI":"10.1128\/mBio.00791-17","article-title":"A novel environmental azole resistance mutation in Aspergillus fumigatus and a possible role of sexual reproduction in its emergence","volume":"8","author":"J Zhang","year":"2017","journal-title":"MBio"},{"key":"ppat.1009711.ref029","doi-asserted-by":"crossref","first-page":"156","DOI":"10.3201\/eid2201.150978","article-title":"Multiple fungicide-driven alterations in azole-resistant Aspergillus fumigatus, Colombia, 2015","volume":"22","author":"P Le Pape","year":"2016","journal-title":"Emerg Infect Dis"},{"key":"ppat.1009711.ref030","doi-asserted-by":"crossref","DOI":"10.4137\/MBI.S24308","article-title":"Fungal presence in selected tree nuts and dried fruits.","volume":"8","author":"VH Tournas","year":"2015","journal-title":"Microbiol Insights."},{"issue":"2","key":"ppat.1009711.ref031","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/S0232-4393(11)80117-4","article-title":"Mycoflora and mycotoxin of hazelnut (Corylus avellana l.) and walnut (Juglans regia l.) seeds in Egypt.","volume":"148","author":"A Abdel-Hafez","year":"1993","journal-title":"Zentralbl Mikrobiol"},{"issue":"4","key":"ppat.1009711.ref032","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1080\/00275514.1975.12019798","article-title":"Fungi occurring in freshly harvested and in-market pecans","volume":"67","author":"LH Huang","year":"1975","journal-title":"Mycologia"},{"issue":"7","key":"ppat.1009711.ref033","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":"SE Schoustra","year":"2019","journal-title":"Emerg Infect Dis"},{"issue":"9","key":"ppat.1009711.ref034","doi-asserted-by":"crossref","first-page":"2443","DOI":"10.1093\/jac\/dkx168","article-title":"Isolation of azole-resistant Aspergillus fumigatus from the environment in the south-eastern USA","volume":"72","author":"SF Hurst","year":"2017","journal-title":"J Antimicrob Chemother"},{"issue":"1","key":"ppat.1009711.ref035","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":"C Yong","year":"2020","journal-title":"Emerg Infect Dis"},{"issue":"4","key":"ppat.1009711.ref036","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.mib.2005.06.017","article-title":"Aspergillus fumigatus: Saprophyte or pathogen?","volume":"8","author":"F Tekaia","year":"2005","journal-title":"Curr Opin Microbiol"},{"issue":"6","key":"ppat.1009711.ref037","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1128\/aem.34.6.765-772.1977","article-title":"Occurrence of Aspergillus fumigatus during composting of sewage sludge","volume":"34","author":"PD Millner","year":"1977","journal-title":"Appl Environ Microbiol"},{"issue":"5","key":"ppat.1009711.ref038","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1128\/aem.39.5.1000-1009.1980","article-title":"Dispersal of Aspergillus fumigatus from sewage sludge compost piles subjected to mechanical agitation in open air","volume":"39","author":"PD Millner","year":"1980","journal-title":"Appl Environ Microbiol"},{"key":"ppat.1009711.ref039","first-page":"417","article-title":"Mycobiota of decomposing floral waste materials","volume":"16","author":"S Shouche","year":"2014","journal-title":"Asian J Microbiol Biotechnol Environ Sci"},{"issue":"6","key":"ppat.1009711.ref040","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1007\/s40265-017-0714-4","article-title":"Triazole resistance in Aspergillus species: An emerging problem.","volume":"77","author":"R Garcia-Rubio","year":"2017","journal-title":"Drugs."},{"issue":"8","key":"ppat.1009711.ref041","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1093\/mmy\/myw047","article-title":"Culturable fungi in potting soils and compost","volume":"54","author":"D Haas","year":"2016","journal-title":"Med Mycol"},{"key":"ppat.1009711.ref042","first-page":"62","article-title":"Principles of epidemiology in public health practice; an introduction to applied epidemiology and biostatistics.","author":"RC Dicker","year":"2006","journal-title":"Principles of Epidemiology in Public Health Practice."},{"issue":"10","key":"ppat.1009711.ref043","doi-asserted-by":"crossref","first-page":"5878","DOI":"10.1128\/AAC.01005-16","article-title":"Epidemiology and molecular characterizations of azole resistance in clinical and environmental Aspergillus fumigatus isolates from China","volume":"60","author":"Y Chen","year":"2016","journal-title":"Antimicrob Agents Chemother"},{"issue":"2","key":"ppat.1009711.ref044","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.jgar.2015.01.005","article-title":"Triazole-resistant Aspergillus fumigatus harbouring G54 mutation: Is it de novo or environmentally acquired?","volume":"3","author":"C Sharma","year":"2015","journal-title":"Journal of Global Antimicrobial Resistance"},{"issue":"4","key":"ppat.1009711.ref045","doi-asserted-by":"crossref","first-page":"131","DOI":"10.3390\/jof4040131","article-title":"Environmental isolates of multi-azole-resistant Aspergillus spp. in southern Italy.","volume":"4","author":"L Trovato","year":"2018","journal-title":"J Fungi (Basel)."},{"issue":"12","key":"ppat.1009711.ref046","doi-asserted-by":"crossref","first-page":"e52871","DOI":"10.1371\/journal.pone.0052871","article-title":"Clonal expansion and emergence of environmental multiple-triazole-resistant Aspergillus fumigatus strains carrying the TR34\/L98H mutations in the cyp51a gene in India.","volume":"7","author":"A Chowdhary","year":"2012","journal-title":"PLoS ONE"},{"key":"ppat.1009711.ref047","article-title":"Isolation of azole-resistant Aspergillus fumigatus from imported plant bulbs in Japan and the effect of fungicide treatment","author":"D. Hagiwara","year":"2020","journal-title":"J Pestic Sci"},{"issue":"1","key":"ppat.1009711.ref048","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1093\/cid\/cix257","article-title":"Intercountry transfer of triazole-resistant Aspergillus fumigatus on plant bulbs","volume":"65","author":"K Dunne","year":"2017","journal-title":"Clin Infect Dis"},{"issue":"4","key":"ppat.1009711.ref049","doi-asserted-by":"crossref","first-page":"e02088","DOI":"10.1128\/AAC.02088-17","article-title":"Azole resistance of environmental and clinical Aspergillus fumigatus isolates from Switzerland","volume":"62","author":"A Riat","year":"2018","journal-title":"Antimicrob Agents Chemother"},{"key":"ppat.1009711.ref050","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1080\/00275514.2018.1557796","article-title":"Fungicide-driven alterations in azole-resistant Aspergillus fumigatus are related to vegetable crops in Colombia, South America.","author":"C Alvarez-Moreno","year":"2019","journal-title":"Mycologia"},{"key":"ppat.1009711.ref051","article-title":"The one health problem of azole resistance in Aspergillus fumigatus: Current insights and future research agenda.","author":"PE Verweij","year":"2020","journal-title":"Fungal Biol Rev"},{"key":"ppat.1009711.ref052","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/09603123.2020.1810210","article-title":"Algorithm to assess the presence of Aspergillus fumigatus resistant strains: The case of norwegian sawmills","author":"C Viegas","year":"2020","journal-title":"Int J Environ Health Res"},{"issue":"1","key":"ppat.1009711.ref053","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1111\/jam.13488","article-title":"Azole-resistant Aspergillus fumigatus in sawmills of eastern France","volume":"123","author":"A Jeanvoine","year":"2017","journal-title":"J Appl Microbiol"},{"issue":"9","key":"ppat.1009711.ref054","doi-asserted-by":"crossref","DOI":"10.1128\/AAC.00548-19","article-title":"Elevated prevalence of azole-resistant Aspergillus fumigatus in urban versus rural environments in the United Kingdom","volume":"63","author":"TR Sewell","year":"2019","journal-title":"Antimicrob Agents Chemother"},{"key":"ppat.1009711.ref055","article-title":"First azole-resistant Aspergillus fumigatus isolates with the environmental TR46 \/Y121f\/T289A mutation in Iran.","author":"F Ahangarkani","year":"2020","journal-title":"Mycoses"},{"issue":"7","key":"ppat.1009711.ref056","doi-asserted-by":"crossref","first-page":"4356","DOI":"10.1128\/AAC.00100-15","article-title":"Environmental isolates of azole-resistant Aspergillus fumigatus in Germany","volume":"59","author":"O Bader","year":"2015","journal-title":"Antimicrob Agents Chemother"},{"key":"ppat.1009711.ref057","article-title":"Evidence for the agricultural origin of antimicrobial resistance in a fungal pathogen of humans.","author":"SE Kang","year":"2020","journal-title":"bioRxiv"},{"key":"ppat.1009711.ref058","doi-asserted-by":"crossref","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":"A Tsitsopoulou","year":"2018","journal-title":"Front Microbiol."},{"issue":"1","key":"ppat.1009711.ref059","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1111\/1462-2920.13988","article-title":"Prevalence, mechanisms and genetic relatedness of the human pathogenic fungus Aspergillus fumigatus exhibiting resistance to medical azoles in the environment of Taiwan","volume":"20","author":"H-C Wang","year":"2018","journal-title":"Environ Microbiol"},{"issue":"1","key":"ppat.1009711.ref060","doi-asserted-by":"crossref","first-page":"45631","DOI":"10.1038\/srep45631","article-title":"Azole-resistant Aspergillus fumigatus harboring TR34\/L98H, TR46\/Y121F\/T289A and TR53 mutations related to flower fields in Colombia.","volume":"7","author":"C Alvarez-Moreno","year":"2017","journal-title":"Sci Rep"},{"issue":"11","key":"ppat.1009711.ref061","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.1016\/j.cmi.2020.06.007","article-title":"How to interpret MICs of antifungal compounds according to the revised clinical breakpoints v.10.0 European Committee on Antimicrobial Susceptibility Testing (EUCAST).","volume":"26","author":"MC Arendrup","year":"2020","journal-title":"Clin Microbiol Infect"},{"key":"ppat.1009711.ref062","article-title":"Azole resistance in Aspergillus species in Southern Taiwan: An epidemiological surveillance study.","author":"YC Chen","year":"2019","journal-title":"Mycoses"},{"key":"ppat.1009711.ref063","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":"J Ren","year":"2017","journal-title":"J Hazard Mater"},{"key":"ppat.1009711.ref064","article-title":"Azole resistance in environmental Aspergillus fumigatus isolates from China: A five-year survey from 2014 to 2018.","author":"D Cao","year":"2020","journal-title":"Antimicrob Agents Chemother"},{"key":"ppat.1009711.ref065","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":"A Prigitano","year":"2019","journal-title":"J Glob Antimicrob Resist"},{"issue":"2","key":"ppat.1009711.ref066","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1111\/ina.12436","article-title":"Emergence of Aspergillus fumigatus azole resistance in azole-na\u00efve patients with chronic obstructive pulmonary disease and their homes.","volume":"28","author":"C Dauchy","year":"2018","journal-title":"Indoor Air."},{"issue":"4","key":"ppat.1009711.ref067","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1111\/jam.14217","article-title":"Aspergillus species collected from environmental air samples in Portugal-molecular identification, antifungal susceptibility and sequencing of cyp51a gene on A. fumigatus sensu stricto itraconazole resistant","author":"C Monteiro","year":"2019","journal-title":"J Appl Microbiol"},{"issue":"12","key":"ppat.1009711.ref068","doi-asserted-by":"crossref","first-page":"20747","DOI":"10.2807\/1560-7917.ES2014.19.12.20747","article-title":"Azole-resistant Aspergillus fumigatus in the environment of northern Italy, May 2011 to June 2012.","volume":"19","author":"A Prigitano","year":"2014","journal-title":"Euro Surveill."},{"key":"ppat.1009711.ref069","unstructured":"Eurostat. Sales of pesticides by type of pesticide. 2020 [cited 2020 Dec 7]. Database: Eurostat Internet. Available from: https:\/\/ec.europa.eu\/eurostat\/tgm\/table.do?tab=table&plugin=1&language=en&pcode=tai02."},{"key":"ppat.1009711.ref070","unstructured":"Food and Agriculture Organization of the United Nations. Land Use. 2020 [cited 2020 Dec 7]. Database: FAOSTAT [Internet]. Available from: http:\/\/www.fao.org\/faostat\/en\/#data\/RL."},{"key":"ppat.1009711.ref071","unstructured":"Food and Agriculture Organization of the United Nations. Pesticides Use. 2020. Database: FAOSTAT [Internet]. Available from: http:\/\/www.fao.org\/faostat\/en\/#data\/RP."},{"key":"ppat.1009711.ref072","unstructured":"U.S. Geological Survey. Estimated Annual Pesticide Use. 2020. Database: Pesticide National Synthesis Project [Internet]. Available from: https:\/\/water.usgs.gov\/nawqa\/pnsp\/usage\/maps\/compound_listing.php?year=2016&hilo=L."},{"issue":"12","key":"ppat.1009711.ref073","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1016\/S1473-3099(09)70265-8","article-title":"Azole resistance in Aspergillus fumigatus: A side-effect of environmental fungicide use?","volume":"9","author":"PE Verweij","year":"2009","journal-title":"Lancet Infect Dis"},{"key":"ppat.1009711.ref074","article-title":"Environmental study of azole-resistant Aspergillus fumigatus with TR34\/L98H mutations in the cyp51a gene in Iran.","volume":"659","author":"H Badali","year":"2013","journal-title":"Mycoses"},{"issue":"4","key":"ppat.1009711.ref075","doi-asserted-by":"crossref","first-page":"27","DOI":"10.29252\/mlj.14.4.27","article-title":"Screening for azole resistance among Aspergillus spp isolated from soil of hospitals and a university campus in Gorgan.","volume":"14","author":"Z Mirshekar","year":"2020","journal-title":"Iran Med Lab J"},{"issue":"1","key":"ppat.1009711.ref076","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.mycmed.2017.12.007","article-title":"Pesticide behavior in paddy fields and development of azole-resistant Aspergillus fumigatus: Should we be concerned?","volume":"28","author":"A Vaezi","year":"2018","journal-title":"Journal de Mycologie M\u00e9dicale."},{"key":"ppat.1009711.ref077","article-title":"Azole-resistant Aspergillus fumigatus in the hospital: Surveillance from flower beds to corridors.","author":"C Godeau","year":"2019","journal-title":"Am J Infect Control."},{"issue":"4","key":"ppat.1009711.ref078","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/ciw326","article-title":"Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America","volume":"63","author":"TF Patterson","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"3","key":"ppat.1009711.ref079","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1086\/338025","article-title":"Cluster of cases of invasive aspergillosis in a transplant intensive care unit: Evidence of person-to-person airborne transmission","volume":"34","author":"DA Pegues","year":"2002","journal-title":"Clin Infect Dis"},{"key":"ppat.1009711.ref080","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.envres.2014.05.009","article-title":"Occurrence of triazole-resistant Aspergillus fumigatus with TR34\/L98H mutations in outdoor and hospital environment in Kuwait","volume":"133","author":"S Ahmad","year":"2014","journal-title":"Environ Res"},{"issue":"11","key":"ppat.1009711.ref081","doi-asserted-by":"crossref","first-page":"2979","DOI":"10.1093\/jac\/dku259","article-title":"Multi-azole-resistant Aspergillus fumigatus in the environment in Tanzania","volume":"69","author":"A Chowdhary","year":"2014","journal-title":"J Antimicrob Chemother"},{"issue":"2","key":"ppat.1009711.ref082","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1093\/jac\/dkt397","article-title":"Azole-resistant Aspergillus fumigatus with the environmental TR46\/Y121F\/T289A mutation in India","volume":"69","author":"A Chowdhary","year":"2014","journal-title":"J Antimicrob Chemother"},{"issue":"4","key":"ppat.1009711.ref083","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 domiciles","volume":"57","author":"JWM Van Der Linden","year":"2013","journal-title":"Clin Infect Dis"}],"container-title":["PLOS Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.ppat.1009711","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T18:23:28Z","timestamp":1627583008000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.ppat.1009711"}},"subtitle":[],"editor":[{"given":"Chaoyang","family":"Xue","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,7,29]]},"references-count":83,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.ppat.1009711","relation":{},"ISSN":["1553-7374"],"issn-type":[{"value":"1553-7374","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,29]]}}}