{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:14:42Z","timestamp":1760145282744,"version":"build-2065373602"},"reference-count":61,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,6,29]],"date-time":"2024-06-29T00:00:00Z","timestamp":1719619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior\u2014Brasil\u2014CAPES (AUXPE)","award":["88881.859210\/2023-01","02-P-9427\/2018"],"award-info":[{"award-number":["88881.859210\/2023-01","02-P-9427\/2018"]}]},{"name":"Science and Technology Research Partnership for Sustainable Development (SATREPS), Japan","award":["88881.859210\/2023-01","02-P-9427\/2018"],"award-info":[{"award-number":["88881.859210\/2023-01","02-P-9427\/2018"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Background: Approximately 60% of individuals with cystic fibrosis (CF) are affected by Aspergillus fumigatus infection. This condition is correlated with a decline in lung function and is identified as an independent risk factor contributing to hospital admissions among CF patients. This study investigates the dynamic interplay of A. fumigatus within the context of CF patients, tracing its evolution over time, with a specific emphasis on colonization dynamics. Methods: An analysis was conducted on 83 sequential A. fumigatus isolates derived from sputum samples of six patients receiving care at a renowned CF hospital in Brazil. Employing microsatellite genotyping techniques, alongside an investigation into cyp51A gene mutations, this research sheds light on the genetic variations, colonization, and resistance of A. fumigatus within the CF respiratory environment. Results: Our research findings indicate that CF patients can harbor A. fumigatus strains from the same clonal complexes for prolonged periods. Additionally, we identified that clinical isolates have the potential to spread among patients in the same healthcare facility, evidencing hospital contamination. Two patients who underwent long-term Itraconazole treatment did not show phenotypic resistance. However, one of these patients exhibited mutations in the cyp51A gene, indicating the need to monitor resistance to azoles in these patients colonized for long periods by A. fumigatus. We also observed co-colonization or co-infection involving multiple genotypes in all patients over time. Conclusion: This comprehensive examination offers valuable insights into the pathogenesis of A. fumigatus infections in CF patients, potentially shaping future therapeutic strategies and management approaches. This enhanced understanding contributes to our knowledge of A. fumigatus impact on disease progression in individuals with cystic fibrosis. Additionally, the study provides evidence of cross-contamination among patients undergoing treatment at the same hospital.<\/jats:p>","DOI":"10.3390\/jof10070461","type":"journal-article","created":{"date-parts":[[2024,7,1]],"date-time":"2024-07-01T10:14:46Z","timestamp":1719828886000},"page":"461","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Insights into Aspergillus fumigatus Colonization in Cystic Fibrosis and Cross-Transmission between Patients and Hospital Environments"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6172-3219","authenticated-orcid":false,"given":"La\u00eds","family":"Pontes","sequence":"first","affiliation":[{"name":"Faculdade de Ci\u00eancias M\u00e9dicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Luisa","family":"Perini Leme Giordano","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias M\u00e9dicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0993-9551","authenticated-orcid":false,"given":"Franqueline","family":"Reichert-Lima","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias M\u00e9dicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caio Augusto","family":"Gualtieri Beraquet","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias M\u00e9dicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guilherme","family":"Leite Pigolli","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias M\u00e9dicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teppei","family":"Arai","sequence":"additional","affiliation":[{"name":"Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba 260-0856, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Dirceu","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias M\u00e9dicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2008-1747","authenticated-orcid":false,"given":"Aline Cristina","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias M\u00e9dicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3057-2937","authenticated-orcid":false,"given":"Akira","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba 260-0856, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustavo Henrique","family":"Goldman","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias Farmac\u00eauticas de Ribeir\u00e3o Preto, Universidade de S\u00e3o Paulo, Ribeir\u00e3o Preto 14040-903, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2280-5649","authenticated-orcid":false,"given":"Maria Luiza","family":"Moretti","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias M\u00e9dicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5095-5054","authenticated-orcid":false,"given":"Ang\u00e9lica","family":"Zaninelli Schreiber","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias M\u00e9dicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S215","DOI":"10.1152\/physrev.1999.79.1.S215","article-title":"Role of CFTR in airway disease","volume":"79","author":"Pilewski","year":"1999","journal-title":"Physiol. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2519","DOI":"10.1016\/S0140-6736(16)00576-6","article-title":"Cystic fibrosis","volume":"388","author":"Elborn","year":"2016","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1055\/s-0039-1694021","article-title":"Cystic Fibrosis: Pathophysiology of Lung Disease","volume":"40","author":"Bergeron","year":"2019","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1097\/MOP.0000000000000627","article-title":"Cystic fibrosis transmembrane conductance regulator modulators: Precision medicine in cystic fibrosis","volume":"30","author":"Burgener","year":"2018","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/1755-7682-1-24","article-title":"Pulmonary bacterial pathogens in cystic fibrosis patients and antibiotic therapy: A tool for the health workers","volume":"1","author":"Coutinho","year":"2008","journal-title":"Int. Arch. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1007\/s11046-021-00574-w","article-title":"Emerging Fungal Threats in Cystic Fibrosis","volume":"186","author":"Schwarz","year":"2021","journal-title":"Mycopathologia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S118","DOI":"10.1093\/mmy\/myy074","article-title":"Aspergillus colonization and antifungal immunity in cystic fibrosis patients","volume":"57","author":"Warris","year":"2019","journal-title":"Med. Mycol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1128\/CMR.12.2.310","article-title":"Aspergillus fumigatus and aspergillosis","volume":"12","year":"1999","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1002\/ppul.25741","article-title":"Clinical characteristics of people with cystic fibrosis and frequent fungal infection","volume":"57","author":"Poore","year":"2022","journal-title":"Pediatr. Pulmonol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Lattanzi, C., Messina, G., Fainardi, V., Tripodi, M.C., Pisi, G., and Esposito, S. (2020). Allergic Bronchopulmonary Aspergillosis in Children with Cystic Fibrosis: An Update on the Newest Diagnostic Tools and Therapeutic Approaches. Pathogens, 9.","DOI":"10.3390\/pathogens9090716"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"229","DOI":"10.2147\/IDR.S63621","article-title":"Aspergillus fumigatus in the cystic fibrosis lung: Pros and cons of azole therapy","volume":"9","author":"Burgel","year":"2016","journal-title":"Infect. Drug Resist."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1378\/chest.09-1103","article-title":"The effect of chronic infection with Aspergillus fumigatus on lung function and hospitalization in patients with cystic fibrosis","volume":"137","author":"Amin","year":"2010","journal-title":"Chest"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1007\/s10096-008-0527-1","article-title":"High-resolution genotyping of Aspergillus fumigatus isolates recovered from chronically colonized patients with cystic fibrosis","volume":"27","author":"Vanhee","year":"2008","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.jcf.2008.10.003","article-title":"Molecular typing and colonization patterns of Aspergillus fumigatus in patients with cystic fibrosis","volume":"8","author":"Klaassen","year":"2009","journal-title":"J. Cyst. Fibros."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1111\/j.1439-0507.2008.01538.x","article-title":"Molecular typing of Aspergillus species","volume":"51","author":"Klaassen","year":"2008","journal-title":"Mycoses"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.mimet.2008.02.011","article-title":"Utility of a microsatellite assay for identifying clonally related outbreak isolates of Aspergillus fumigatus","volume":"73","author":"Balajee","year":"2008","journal-title":"J. Microbiol. Methods"},{"key":"ref_17","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":"Camps","year":"2013","journal-title":"Clin. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1093\/jac\/dku410","article-title":"Concomitant occurrence of itraconazole-resistant and -susceptible strains of Aspergillus fumigatus in routine cultures","volume":"70","author":"Ahmad","year":"2015","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Arendrup, M.C., Mavridou, E., Mortensen, K.L., Snelders, E., Frimodt-Moller, N., Khan, H., Melchers, W.J.G., and Verweij, P.E. (2010). Development of azole resistance in Aspergillus fumigatus during azole therapy associated with change in virulence. PLoS ONE, 5.","DOI":"10.1371\/journal.pone.0010080"},{"key":"ref_20","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. Env. Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Snelders, E., Camps, S.M., Karawajczyk, A., Schaftenaar, G., Kema, G.H., van der Lee, H.A., Klaassen, C.H., Melchers, W.J.G., and Verweij, P.E. (2012). Triazole fungicides can induce cross-resistance to medical triazoles in Aspergillus fumigatus. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0031801"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1128\/AAC.05077-11","article-title":"High prevalence of azole-resistant Aspergillus fumigatus in adults with cystic fibrosis exposed to itraconazole","volume":"56","author":"Burgel","year":"2012","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2343","DOI":"10.1128\/JCM.00502-15","article-title":"High-Level Pan-Azole-Resistant Aspergillosis","volume":"53","author":"Rijs","year":"2015","journal-title":"J. Clin. Microbiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2894","DOI":"10.1093\/jac\/dkv177","article-title":"High prevalence of azole resistance in Aspergillus fumigatus isolates from high-risk patients","volume":"70","author":"Fuhren","year":"2015","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1093\/jac\/dkh507","article-title":"Mutations in the cyp51A gene and susceptibility to itraconazole in Aspergillus fumigatus serially isolated from a patient with lung aspergilloma","volume":"55","author":"Chen","year":"2005","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1093\/jac\/dkr443","article-title":"Isolation of multiple-triazole-resistant Aspergillus fumigatus strains carrying the TR\/L98H mutations in the cyp51A gene in India","volume":"67","author":"Chowdhary","year":"2012","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2425","DOI":"10.1128\/AAC.01599-09","article-title":"Azole resistance profile of amino acid changes in Aspergillus fumigatus CYP51A based on protein homology modeling","volume":"54","author":"Snelders","year":"2010","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1128\/JCM.03216-14","article-title":"Validation of a new Aspergillus real-time PCR assay for direct detection of Aspergillus and azole resistance of Aspergillus fumigatus on bronchoalveolar lavage fluid","volume":"53","author":"Chong","year":"2015","journal-title":"J. Clin. Microbiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"17087","DOI":"10.1038\/s41598-021-96651-7","article-title":"Development and validation of LAMP primer sets for rapid identification of Aspergillus fumigatus carrying the cyp51A TR(46) azole resistance gene","volume":"11","author":"Trabasso","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1128\/AAC.02271-19","article-title":"A Simple Method To Detect Point Mutations in Aspergillus fumigatus cyp51A Gene Using a Surveyor Nuclease Assay","volume":"64","author":"Arai","year":"2020","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1590\/S0036-46651992000200012","article-title":"Preservation of fungi and actinomycetes of medical importance in distilled water","volume":"34","author":"Rodrigues","year":"1992","journal-title":"Rev. Inst. Med. Trop. Sao Paulo"},{"key":"ref_32","unstructured":"Lacaz, S.C., Porto, E., Martins, J.E.C., Heinz-Vacari, E.M., and Takahashi de Melo, N. (2002). Tratado de Micologia M\u00e9dica. 9, Sarvier."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"39","DOI":"10.3114\/sim.2007.59.05","article-title":"Aspergillus species identification in the clinical setting","volume":"59","author":"Balajee","year":"2007","journal-title":"Stud. Mycol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1128\/AAC.02059-19","article-title":"Aspergillus fumigatus Clinical Isolates Carrying CYP51A with TR34\/L98H\/S297T\/F495I Substitutions Detected after Four-Year Retrospective Azole Resistance Screening in Brazil","volume":"64","author":"Pontes","year":"2020","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1128\/JCM.39.7.2431-2438.2001","article-title":"Identification of two different 14-alpha sterol demethylase-related genes (cyp51A and cyp51B) in Aspergillus fumigatus and other Aspergillus species","volume":"39","author":"Mellado","year":"2001","journal-title":"J. Clin. Microbiol."},{"key":"ref_36","unstructured":"(2017). Reference Method for Broth Dilution Antifungal Susceptibility Testing of Filamentous Fungi Approved Standard\u2014Second Edition (Standard No. CLSI M38-A3)."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"S50","DOI":"10.1016\/j.jinf.2016.04.022","article-title":"Aspergillus infections in cystic fibrosis","volume":"72","author":"King","year":"2016","journal-title":"J. Infect."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1007\/s10096-015-2474-y","article-title":"Aspergillus fumigatus chronic colonization and lung function decline in cystic fibrosis may have a two-way relationship","volume":"34","author":"Noni","year":"2015","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1111\/myc.13139","article-title":"High prevalence of triazole-resistant Aspergillus fumigatus sensu stricto in an Argentinean cohort of patients with cystic fibrosis","volume":"63","author":"Posse","year":"2020","journal-title":"Mycoses"},{"key":"ref_40","first-page":"937","article-title":"Aspergillus fumigatus and Aspergillosis in 2019","volume":"33","author":"Chamilos","year":"2019","journal-title":"Clin Microbiol Rev"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"570.e1","DOI":"10.1016\/j.cmi.2016.04.001","article-title":"Azole-resistant Aspergillus fumigatus in Denmark: A laboratory-based study on resistance mechanisms and genotypes","volume":"22","author":"Jensen","year":"2016","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"de Groot, T., and Meis, J.F. (2019). Microsatellite Stability in STR Analysis Aspergillus fumigatus Depends on Number of Repeat Units. Front. Cell Infect. Microbiol., 9.","DOI":"10.3389\/fcimb.2019.00082"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"van der Torre, M.H., Shen, H., Rautemaa-Richardson, R., Richardson, M.D., and Novak-Frazer, L. (2021). Molecular Epidemiology of Aspergillus fumigatus in Chronic Pulmonary Aspergillosis Patients. J. Fungi, 7.","DOI":"10.3390\/jof7020152"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1086\/676882","article-title":"Infection prevention and control guideline for cystic fibrosis: 2013 update","volume":"35","author":"Saiman","year":"2014","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"797","DOI":"10.3201\/eid2504.181110","article-title":"Aerosol Transmission of Aspergillus fumigatus in Cystic Fibrosis Patients in the Netherlands","volume":"25","author":"Engel","year":"2019","journal-title":"Emerg. Infect. Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"00020","DOI":"10.1183\/23120541.00020-2020","article-title":"Parasexual recombination enables Aspergillus fumigatus to persist in cystic fibrosis","volume":"6","author":"Engel","year":"2020","journal-title":"ERJ Open Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1002\/ps.3390","article-title":"Triazole fungicides and the selection of resistance to medical triazoles in the opportunistic mould Aspergillus fumigatus","volume":"69","author":"Verweij","year":"2013","journal-title":"Pest. Manag. Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"4948","DOI":"10.1128\/AAC.05990-11","article-title":"Azole preexposure affects the Aspergillus fumigatus population in patients","volume":"56","author":"Alanio","year":"2012","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.mmcr.2022.02.002","article-title":"Selection of Aspergillus fumigatus isolates carrying the G448S substitution in CYP51A gene after long-term treatment with voriconazole in an immunocompromised patient","volume":"36","author":"Pontes","year":"2022","journal-title":"Med. Mycol. Case Rep."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Pontes, L., Arai, T., Beraquet, C.A.G., Giordano, A.L.P.L., Reichert-Lima, F., Luz, E.A.d., S\u00e1, C.F.d., Levy, L.O., Tararam, C.A., and Watanabe, A. (2024). Uncovering a Novel cyp51A Mutation and Antifungal Resistance in Aspergillus fumigatus through Culture Collection Screening. J. Fungi, 10.","DOI":"10.3390\/jof10020122"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Chen, P., Liu, M., Zeng, Q., Zhang, Z., Liu, W., Sang, H., and Lu, L. (2019). Uncovering New Mutations Conferring Azole Resistance in the Aspergillus fumigatus cyp51A Gene. Front. Microbiol., 10.","DOI":"10.3389\/fmicb.2019.03127"},{"key":"ref_52","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":"Chen","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1093\/mmy\/myaa110","article-title":"CYP51A polymorphisms of Aspergillus fumigatus in lung transplant recipients: Prevalence, correlation with phenotype, and impact on outcomes","volume":"59","author":"Henry","year":"2021","journal-title":"Med. Mycol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1099\/jmm.0.000255","article-title":"High prevalence of clinical and environmental triazole-resistant Aspergillus fumigatus in Iran: Is it a challenging issue?","volume":"65","author":"Nabili","year":"2016","journal-title":"J. Med. Microbiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2468","DOI":"10.1128\/AAC.00156-08","article-title":"Epidemiological cutoffs and cross-resistance to azole drugs in Aspergillus fumigatus","volume":"52","author":"Mellado","year":"2008","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1111\/myc.12759","article-title":"Surveillance for azoles resistance in Aspergillus spp. highlights a high number of amphotericin B-resistant isolates","volume":"61","author":"Lyra","year":"2018","journal-title":"Mycoses"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1080\/12298093.2020.1744955","article-title":"Antifungal Susceptibility Tests and the cyp51 Mutant Strains among Clinical Aspergillus fumigatus Isolates from Korean Multicenters","volume":"48","author":"Won","year":"2020","journal-title":"Mycobiology"},{"key":"ref_58","first-page":"10","article-title":"Insight into the Significance of Aspergillus fumigatus cyp51A Polymorphisms","volume":"62","author":"Monteiro","year":"2018","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2460","DOI":"10.1128\/AAC.01358-10","article-title":"Aspergillus fumigatus strains with mutations in the cyp51A gene do not always show phenotypic resistance to itraconazole, voriconazole, or posaconazole","volume":"55","author":"Escribano","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.bjid.2017.10.005","article-title":"In vitro antifungal susceptibility of clinical and environmental isolates of Aspergillus fumigatus and Aspergillus flavus in Brazil","volume":"22","author":"Zanette","year":"2018","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"ofae082","DOI":"10.1093\/ofid\/ofae082","article-title":"Modeling Invasive Aspergillosis Risk for the Application of Prophylaxis Strategies","volume":"11","author":"Young","year":"2024","journal-title":"Open Forum Infect. Dis."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/10\/7\/461\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:07:33Z","timestamp":1760108853000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/10\/7\/461"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,29]]},"references-count":61,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["jof10070461"],"URL":"https:\/\/doi.org\/10.3390\/jof10070461","relation":{},"ISSN":["2309-608X"],"issn-type":[{"type":"electronic","value":"2309-608X"}],"subject":[],"published":{"date-parts":[[2024,6,29]]}}}