{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T22:54:10Z","timestamp":1787612050456,"version":"build-2736575974"},"reference-count":253,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,25]],"date-time":"2025-01-25T00:00:00Z","timestamp":1737763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>As azole-resistant Aspergillus fumigatus emerges globally, healthcare facilities face mounting challenges in managing invasive aspergillosis. This review synthesizes worldwide azole resistance data to reveal profound regional variability, demonstrating that findings from other regions cannot be directly extrapolated to local settings. Consequently, hospital-level environmental surveillance is crucial for tailoring interventions to local epidemiology and detecting resistant strains in real-time. We outline practical approaches\u2014encompassing sampling site prioritization, diagnostic workflows (culture-based and molecular), and PDCA-driven continuous improvement\u2014so that even resource-limited facilities can manage resistant isolates more effectively. By linking real-time surveillance findings with clinical decisions, hospitals can tailor antifungal stewardship programs and swiftly adjust prophylaxis or treatment regimens. Our approach aims to enable accurate, ongoing evaluations of emerging resistance patterns, ensuring that institutions maintain efficient and adaptive programs. Ultimately, we advocate for sustained, collaborative efforts worldwide, where facilities adapt protocols to local conditions, share data through international networks, and contribute to a global knowledge base on resistance mechanisms. Through consistent application of these recommendations, healthcare systems can better preserve azole efficacy, safeguard immunocompromised populations, and refine infection control practices in the face of evolving challenges.<\/jats:p>","DOI":"10.3390\/jof11020096","type":"journal-article","created":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T08:57:48Z","timestamp":1738054668000},"page":"96","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Comprehensive Review of Environmental Surveillance for Azole-Resistant Aspergillus fumigatus: A Practical Roadmap for Hospital Clinicians and Infection Control Teams"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7609-7679","authenticated-orcid":false,"given":"Masato","family":"Tashiro","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"},{"name":"Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichiro","family":"Nakano","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0458-3090","authenticated-orcid":false,"given":"Tomoyuki","family":"Shirahige","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4957-3857","authenticated-orcid":false,"given":"Satoshi","family":"Kakiuchi","sequence":"additional","affiliation":[{"name":"Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayumi","family":"Fujita","sequence":"additional","affiliation":[{"name":"Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0768-9528","authenticated-orcid":false,"given":"Takeshi","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0696-5386","authenticated-orcid":false,"given":"Takahiro","family":"Takazono","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"},{"name":"Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Izumikawa","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan"},{"name":"Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1093\/cid\/civ885","article-title":"Azole Resistance in Aspergillus fumigatus: Can We Retain the Clinical Use of Mold-Active Antifungal Azoles?","volume":"62","author":"Verweij","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e00140-18","DOI":"10.1128\/CMR.00140-18","article-title":"Aspergillus fumigatus and Aspergillosis in 2019","volume":"33","author":"Latge","year":"2019","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_3","first-page":"2","article-title":"Biofilm formation by Aspergillus fumigatus","volume":"52","author":"Kaur","year":"2014","journal-title":"Med. Mycol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/S0140-6736(15)01159-9","article-title":"Isavuconazole versus voriconazole for primary treatment of invasive mould disease caused by Aspergillus and other filamentous fungi (SECURE): A phase 3, randomised-controlled, non-inferiority trial","volume":"387","author":"Maertens","year":"2016","journal-title":"Lancet"},{"key":"ref_5","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":"Patterson","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1056\/NEJMoa061094","article-title":"Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia","volume":"356","author":"Cornely","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S436","DOI":"10.1093\/infdis\/jix210","article-title":"Azole-Resistant Aspergillosis: Epidemiology, Molecular Mechanisms, and Treatment","volume":"216","author":"Chowdhary","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref_8","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":"ref_9","unstructured":"World Health Organization (2022). WHO Fungal Priority Pathogens List to Guide Research, Development and Public Health Action, WHO."},{"key":"ref_10","unstructured":"Centers for Disease Control Prevention (CDC) (2019). Antibiotic Resistance Threats in the United States, 2019, U.S. Department of Health and Human Services."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"myad129","DOI":"10.1093\/mmy\/myad129","article-title":"Aspergillus fumigatus-a systematic review to inform the World Health Organization priority list of fungal pathogens","volume":"62","author":"Morrissey","year":"2024","journal-title":"Med. Mycol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"4870","DOI":"10.1128\/AAC.00514-12","article-title":"Correlation between triazole treatment history and susceptibility in clinically isolated Aspergillus fumigatus","volume":"56","author":"Tashiro","year":"2012","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Burks, C., Darby, A., Gomez Londono, L., Momany, M., and Brewer, M.T. (2021). Azole-resistant Aspergillus fumigatus in the environment: Identifying key reservoirs and hotspots of antifungal resistance. PLoS Pathog., 17.","DOI":"10.1371\/journal.ppat.1009711"},{"key":"ref_14","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":"ref_15","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1038\/s41564-022-01091-2","article-title":"Population genomics confirms acquisition of drug-resistant Aspergillus fumigatus infection by humans from the environment","volume":"7","author":"Rhodes","year":"2022","journal-title":"Nat. Microbiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2079","DOI":"10.1093\/jac\/dkw259","article-title":"Azole resistance surveillance in Aspergillus fumigatus: Beneficial or biased?","volume":"71","author":"Verweij","year":"2016","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.3201\/eid2607.200088","article-title":"Paradoxal Trends in Azole-Resistant Aspergillus fumigatus in a National Multicenter Surveillance Program, the Netherlands, 2013\u20132018","volume":"26","author":"Lestrade","year":"2020","journal-title":"Emerg. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Goncalves, P., Melo, A., Dias, M., Almeida, B., Caetano, L.A., Verissimo, C., Viegas, C., and Sabino, R. (2020). Azole-Resistant Aspergillus fumigatus Harboring the TR(34)\/L98H Mutation: First Report in Portugal in Environmental Samples. Microorganisms, 9.","DOI":"10.3390\/microorganisms9010057"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Douglas, A.P., Stewart, A.G., Halliday, C.L., and Chen, S.C. (2023). Outbreaks of Fungal Infections in Hospitals: Epidemiology, Detection, and Management. J. Fungi, 9.","DOI":"10.3390\/jof9111059"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e018109","DOI":"10.1136\/bmjopen-2017-018109","article-title":"Monitoring of clinical strains and environmental fungal aerocontamination to prevent invasive aspergillosis infections in hospital during large deconstruction work: A protocol study","volume":"7","author":"Loeffert","year":"2017","journal-title":"BMJ Open"},{"key":"ref_21","unstructured":"European Centre for Disease Prevention Control (2013). Risk Assessment on the Impact of Environmental Usage of Triazoles on the Development and Spread of Resistance to Medical Triazoles in Aspergillus Species, European Centre for Disease Prevention and Control. Report no. 978-92-9193-444-7."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1093\/cid\/ciz1008","article-title":"Revision and Update of the Consensus Definitions of Invasive Fungal Disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium","volume":"71","author":"Donnelly","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S180","DOI":"10.1111\/j.1600-6143.2009.02910.x","article-title":"Invasive aspergillosis in solid organ transplant recipients","volume":"9","author":"Singh","year":"2009","journal-title":"Am. J. Transplant."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Righi, I., Barone, I., Rosso, L., Morlacchi, L.C., Rossetti, V., Caffarena, G., Limanaqi, F., Palleschi, A., Clerici, M., and Trabattoni, D. (2024). Immunopathology of lung transplantation: From infection to rejection and vice versa. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1433469"},{"key":"ref_25","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_26","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.healun.2016.01.007","article-title":"The 2015 International Society for Heart and Lung Transplantation Guidelines for the management of fungal infections in mechanical circulatory support and cardiothoracic organ transplant recipients: Executive summary","volume":"35","author":"Husain","year":"2016","journal-title":"J. Heart Lung Transplant."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S121","DOI":"10.1093\/cid\/ciaa1751","article-title":"EORTC\/MSGERC Definitions of Invasive Fungal Diseases: Summary of Activities of the Intensive Care Unit Working Group","volume":"72","author":"Bassetti","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_28","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_29","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.3201\/eid1710.110226","article-title":"Clinical implications of azole resistance in Aspergillus fumigatus, The Netherlands, 2007\u20132009","volume":"17","author":"Snelders","year":"2011","journal-title":"Emerg. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.drup.2015.08.001","article-title":"International expert opinion on the management of infection caused by azole-resistant Aspergillus fumigatus","volume":"21\u201322","author":"Verweij","year":"2015","journal-title":"Drug Resist. Updates"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"jkab427","DOI":"10.1093\/g3journal\/jkab427","article-title":"Evidence for the agricultural origin of resistance to multiple antimicrobials in Aspergillus fumigatus, a fungal pathogen of humans","volume":"12","author":"Kang","year":"2022","journal-title":"G3"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/j.jiac.2020.05.008","article-title":"Characteristics of azole-resistant Aspergillus fumigatus attached to agricultural products imported to Japan","volume":"26","author":"Nakano","year":"2020","journal-title":"J. Infect. Chemother."},{"key":"ref_33","unstructured":"Health Protection Surveillance Centre (2018). National Guidelines for the Prevention of Nosocomial Aspergillosis, Health Protection Surveillance Centre."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Chen, S., Zhu, G., Lin, H., Guo, J., Deng, S., Wu, W., Goldman, G.H., Lu, L., and Zhang, Y. (2024). Variability in competitive fitness among environmental and clinical azole-resistant Aspergillus fumigatus isolates. mBio, 15.","DOI":"10.1128\/mbio.00263-24"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1093\/jac\/dkz534","article-title":"Prevalence and mechanisms of azole resistance in clinical isolates of Aspergillus section Fumigati species in a Canadian tertiary care centre, 2000 to 2013","volume":"75","author":"Dufresne","year":"2020","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1093\/jac\/dkz121","article-title":"Azole resistance and cyp51A mutation screening in Aspergillus fumigatus in Mexico","volume":"74","author":"Valenzuela","year":"2019","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Badali, H., Canete-Gibas, C., McCarthy, D., Patterson, H., Sanders, C., David, M.P., Mele, J., Fan, H., and Wiederhold, N.P. (2022). Species Distribution and Antifungal Susceptibilities of Aspergillus Section Fumigati Isolates in Clinical Samples from the United States. J. Clin. Microbiol., 60.","DOI":"10.1128\/jcm.00280-22"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Pfaller, M.A., Carvalhaes, C.G., Rhomberg, P.R., Desphande, L.M., and Castanheira, M. (2024). Trends in the activity of mold-active azole agents against Aspergillus fumigatus clinical isolates with and without cyp51 alterations from Europe and North America (2017\u20132021). J. Clin. Microbiol., 62.","DOI":"10.1128\/jcm.01141-23"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"da Fonseca, L.M.M., Braga, V.F., Tonani, L., Grizante Bariao, P.H., Nascimento, E., Martinez, R., and von Zeska Kress, M.R. (2023). Surveillance of Amphotericin B and Azole Resistance in Aspergillus Isolated from Patients in a Tertiary Teaching Hospital. J. Fungi, 9.","DOI":"10.3390\/jof9111070"},{"key":"ref_40","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_41","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1093\/mmy\/myaa052","article-title":"High detection rate of azole-resistant Aspergillus fumigatus after treatment with azole antifungal drugs among patients with chronic pulmonary aspergillosis in a single hospital setting with low azole resistance","volume":"59","author":"Takeda","year":"2021","journal-title":"Med. Mycol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1093\/mmy\/myz003","article-title":"Prospective multicenter surveillance of clinically isolated Aspergillus species revealed azole-resistant Aspergillus fumigatus isolates with TR34\/L98H mutation in the Kyoto and Shiga regions of Japan","volume":"57","author":"Tsuchido","year":"2019","journal-title":"Med. Mycol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"5451","DOI":"10.2147\/IDR.S495250","article-title":"Epidemiology and Antifungal Susceptibilities of Clinically Isolated Aspergillus Species in Tertiary Hospital of Southeast China","volume":"17","author":"Hussain","year":"2024","journal-title":"Infect. Drug Resist."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1016\/j.jiac.2016.03.002","article-title":"Azole susceptibility in clinical and environmental isolates of Aspergillus fumigatus from eastern Hokkaido, Japan","volume":"22","author":"Toyotome","year":"2016","journal-title":"J. Infect. Chemother."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1111\/myc.13008","article-title":"Azole resistance in Aspergillus species in Southern Taiwan: An epidemiological surveillance study","volume":"62","author":"Chen","year":"2019","journal-title":"Mycoses"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"4641","DOI":"10.1111\/1462-2920.16154","article-title":"High prevalence and genetic diversity of a single ancestral origin azole-resistant Aspergillus fumigatus in indoor environments at Walailak University, Southern Thailand","volume":"24","author":"Daloh","year":"2022","journal-title":"Environ. Microbiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e00066-21","DOI":"10.1128\/mSphere.00066-21","article-title":"Extensive Genetic Diversity and Widespread Azole Resistance in Greenhouse Populations of Aspergillus fumigatus in Yunnan, China","volume":"6","author":"Zhou","year":"2021","journal-title":"mSphere"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"7632","DOI":"10.1111\/1462-2920.15660","article-title":"Azole-resistant Aspergillus fumigatus is highly prevalent in the environment of Vietnam, with marked variability by land use type","volume":"23","author":"Duong","year":"2021","journal-title":"Environ. Microbiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1007\/s15010-024-02236-7","article-title":"Report of three azole-resistant Aspergillus fumigatus cases with TR34\/L98H mutation in hematological patients in Barcelona, Spain","volume":"52","author":"Chumbita","year":"2024","journal-title":"Infection"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jhin.2023.12.011","article-title":"Electronic equipment and appliances in special wards of hospitals as a source of azole-resistant Aspergillus fumigatus: A multi-centre study from Iran","volume":"145","author":"Ghazanfari","year":"2024","journal-title":"J. Hosp. Infect."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Ahangarkani, F., Badali, H., Abbasi, K., Nabili, M., Khodavaisy, S., de Groot, T., and Meis, J.F. (2020). Clonal Expansion of Environmental Triazole Resistant Aspergillus fumigatus in Iran. J. Fungi, 6.","DOI":"10.3390\/jof6040199"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Resendiz-Sharpe, A., Dewaele, K., Merckx, R., Bustamante, B., Vega-Gomez, M.C., Rolon, M., Jacobs, J., Verweij, P.E., Maertens, J., and Lagrou, K. (2021). Triazole-Resistance in Environmental Aspergillus fumigatus in Latin American and African Countries. J. Fungi, 7.","DOI":"10.3390\/jof7040292"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e13732","DOI":"10.1111\/myc.13732","article-title":"First detection of triazole-resistant Aspergillus fumigatus harbouring the TR34\/L98H Cyp51A mutation in Burkina Faso","volume":"67","author":"Yerbanga","year":"2024","journal-title":"Mycoses"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Yerbanga, I.W., Resendiz-Sharpe, A., Bamba, S., Lagrou, K., Nakanabo Diallo, S., Rodriguez-Villalobos, H., Denis, O., and Montesinos, I. (2021). First Investigative Study of Azole-Resistant Aspergillus fumigatus in the Environment in Burkina Faso. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18052250"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Kemoi, E.K., Nyerere, A., and Bii, C.C. (2018). Triazole-Resistant Aspergillus fumigatus from Fungicide-Experienced Soils in Naivasha Subcounty and Nairobi County, Kenya. Int. J. Microbiol., 2018.","DOI":"10.1155\/2018\/7147938"},{"key":"ref_56","first-page":"20499361211044330","article-title":"Triazole susceptibility of Aspergillus species: Environmental survey in Lagos, Nigeria and review of the rest of Africa","volume":"8","author":"Campbell","year":"2021","journal-title":"Ther. Adv. Infect. Dis."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1139\/cjm-2017-0410","article-title":"Limited evidence of fungicide-driven triazole-resistant Aspergillus fumigatus in Hamilton, Canada","volume":"64","author":"Ashu","year":"2018","journal-title":"Can. J. Microbiol."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Wang, C., Miller, N., Vines, D., Severns, P.M., Momany, M., and Brewer, M.T. (2024). Azole resistance mechanisms and population structure of the human pathogen Aspergillus fumigatus on retail plant products. Appl. Environ. Microbiol., 90.","DOI":"10.1128\/aem.02056-23"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Celia-Sanchez, B.N., Mangum, B., Gomez Londono, L.F., Wang, C., Shuman, B., Brewer, M.T., and Momany, M. (2024). Pan-azole- and multi-fungicide-resistant Aspergillus fumigatus is widespread in the United States. Appl. Environ. Microbiol., 90.","DOI":"10.1128\/aem.01782-23"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Jimenez Madrid, M.A., Paul, R.A., Rotondo, F., Deblais, L., Rajashekara, G., Miller, S.A., and Ivey, M.L.L. (2024). Triazole resistance in Aspergillus fumigatus isolated from a tomato production environment exposed to propiconazole. Appl. Environ. Microbiol., 90.","DOI":"10.1128\/aem.00017-24"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e02240-17","DOI":"10.1128\/AAC.02240-17","article-title":"Detection of TR(34)\/L98H CYP51A Mutation through Passive Surveillance for Azole-Resistant Aspergillus fumigatus in the United States from 2015 to 2017","volume":"62","author":"Berkow","year":"2018","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_62","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":"ref_63","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_64","doi-asserted-by":"crossref","unstructured":"Melo, A.M., Poester, V.R., Trapaga, M.R., Faria, F.A., Aquino, V., Severo, C.B., Stevens, D.A., Verissimo, C., Sabino, R., and Xavier, M.O. (2024). Aspergillus fumigatus sensu stricto genetic diversity from cystic fibrosis patients. Int. J. Med. Microbiol., 317.","DOI":"10.1016\/j.ijmm.2024.151639"},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Melhem, M.S.C., Coelho, V.C., Fonseca, C.A., Oliveira, L., Bonfietti, L.X., Szeszs, M.W., Magri, M.M.C., Dorneles, F.S., Taguchi, H., and Moreira, D.V.S. (2022). Evaluation of the Sensititre YeastOne and Etest in Comparison with CLSI M38-A2 for Antifungal Susceptibility Testing of Three Azoles, Amphotericin B, Caspofungin, and Anidulafungin, against Aspergillus fumigatus and Other Species, Using New Clinical Breakpoints and Epidemiological Cutoff Values. Pharmaceutics, 14.","DOI":"10.3390\/pharmaceutics14102161"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"e02059-19","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_67","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_68","doi-asserted-by":"crossref","first-page":"e00608-17","DOI":"10.1128\/AAC.00608-17","article-title":"Triazole Resistance Is Still Not Emerging in Aspergillus fumigatus Isolates Causing Invasive Aspergillosis in Brazilian Patients","volume":"61","author":"Negri","year":"2017","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.riam.2024.04.003","article-title":"Azole resistance in a clinical isolate of Aspergillus fumigatus from Chile","volume":"41","author":"Cepeda","year":"2024","journal-title":"Rev. Iberoam. Micol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1093\/mmy\/myz032","article-title":"Azole resistance among clinical isolates of Aspergillus fumigatus in Lima-Peru","volume":"58","author":"Bustamante","year":"2020","journal-title":"Med. Mycol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"427","DOI":"10.2147\/IDR.S440363","article-title":"Epidemiology and Azole Resistance of Clinical Isolates of Aspergillus fumigatus from a Large Tertiary Hospital in Ningxia, China","volume":"17","author":"Kang","year":"2024","journal-title":"Infect. Drug Resist."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"102612","DOI":"10.1016\/j.jiph.2024.102612","article-title":"Epidemiological characteristics of invasive Aspergillus isolates: Morphology, drug susceptibility, and mutations in azole drug targets","volume":"18","author":"Zhang","year":"2025","journal-title":"J. Infect. Public Health"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Gong, J., Huang, J., Liu, Y., Zhang, Y., and Gao, Y. (2024). Unveiling environmental transmission risks: Comparative analysis of azole resistance in Aspergillus fumigatus clinical and environmental isolates from Yunnan, China. Microbiol. Spectr., 12.","DOI":"10.1128\/spectrum.01594-24"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"4645","DOI":"10.2147\/IDR.S417840","article-title":"Epidemiology of Clinically Significant Aspergillus Species from a Large Tertiary Hospital in Shanghai, China, for the Period of Two Years","volume":"16","author":"Zhang","year":"2023","journal-title":"Infect. Drug Resist."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"myad082","DOI":"10.1093\/mmy\/myad082","article-title":"In vitro antifungal susceptibility profile and genotypic characterization of clinical Aspergillus isolates in Eastern China on behalf of Eastern China Invasive Fungi Infection Group","volume":"61","author":"Lin","year":"2023","journal-title":"Med. Mycol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e0007123","DOI":"10.1128\/msphere.00071-23","article-title":"Genetic structure and triazole resistance among Aspergillus fumigatus populations from remote and undeveloped regions in Eastern Himalaya","volume":"8","author":"Zhou","year":"2023","journal-title":"mSphere"},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Wang, Y., Zhang, L., Zhou, L., Zhang, M., and Xu, Y. (2022). Epidemiology, Drug Susceptibility, and Clinical Risk Factors in Patients With Invasive Aspergillosis. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.835092"},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Yang, X., Chen, W., Liang, T., Tan, J., Liu, W., Sun, Y., Wang, Q., Xu, H., Li, L., and Zhou, Y. (2021). A 20-Year Antifungal Susceptibility Surveillance (From 1999 to 2019) for Aspergillus spp. and Proposed Epidemiological Cutoff Values for Aspergillus fumigatus and Aspergillus flavus: A Study in a Tertiary Hospital in China. Front. Microbiol., 12.","DOI":"10.3389\/fmicb.2021.680884"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"3041","DOI":"10.1021\/acs.est.0c03958","article-title":"Prevalence of Azole-Resistant Aspergillus fumigatus is Highly Associated with Azole Fungicide Residues in the Fields","volume":"55","author":"Cao","year":"2021","journal-title":"Environ. Sci. Technol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"e00904-20","DOI":"10.1128\/AAC.00904-20","article-title":"Five-Year Survey (2014 to 2018) of Azole Resistance in Environmental Aspergillus fumigatus Isolates from China","volume":"64","author":"Cao","year":"2020","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_81","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":"ref_82","doi-asserted-by":"crossref","first-page":"665","DOI":"10.4103\/0366-6999.201609","article-title":"Triazole Resistance in Aspergillus fumigatus Clinical Isolates Obtained in Nanjing, China","volume":"130","author":"Zhang","year":"2017","journal-title":"Chin. Med. J."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"e109","DOI":"10.1038\/emi.2017.97","article-title":"Triazole phenotypes and genotypic characterization of clinical Aspergillus fumigatus isolates in China","volume":"6","author":"Deng","year":"2017","journal-title":"Emerg. Microbes Infect."},{"key":"ref_84","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_85","first-page":"e54586","article-title":"Antifungal Susceptibility Profile of Clinical and Environmental Isolates of Aspergillus Species From a Tertiary Care Center in North India","volume":"16","author":"Kaur","year":"2024","journal-title":"Cureus"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"e02264-17","DOI":"10.1128\/AAC.02264-17","article-title":"Emergence of Azole-Resistant Aspergillus fumigatus from Immunocompromised Hosts in India","volume":"62","author":"Dabas","year":"2018","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Chowdhary, A., Sharma, C., Kathuria, S., Hagen, F., and Meis, J.F. (2015). Prevalence and mechanism of triazole resistance in Aspergillus fumigatus in a referral chest hospital in Delhi, India and an update of the situation in Asia. Front. Microbiol., 6.","DOI":"10.3389\/fmicb.2015.00428"},{"key":"ref_88","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_89","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.3855\/jidc.13135","article-title":"Molecular typing and antifungal susceptibility study of Aspergillus spp. in intensive care unit (ICU) patients in Indonesia","volume":"15","author":"Rozaliyani","year":"2021","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.jiac.2020.11.027","article-title":"Transition of triazole-resistant Aspergillus fumigatus isolates in a Japanese tertiary hospital and subsequent genetic analysis","volume":"27","author":"Takazono","year":"2021","journal-title":"J. Infect. Chemother."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.jiac.2019.09.002","article-title":"Prospective survey of Aspergillus species isolated from clinical specimens and their antifungal susceptibility: A five-year single-center study in Japan","volume":"26","author":"Toyotome","year":"2020","journal-title":"J. Infect. Chemother."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.jiac.2014.01.003","article-title":"Antifungal susceptibility of Aspergillus fumigatus clinical isolates collected from various areas in Japan","volume":"20","author":"Kikuchi","year":"2014","journal-title":"J. Infect. Chemother."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1128\/AAC.05394-11","article-title":"Antifungal susceptibilities of Aspergillus fumigatus clinical isolates obtained in Nagasaki, Japan","volume":"56","author":"Tashiro","year":"2012","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_94","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_95","doi-asserted-by":"crossref","first-page":"2159","DOI":"10.2147\/IDR.S452619","article-title":"Antifungal Susceptibility and Genotypic Analysis of cyp51A Mutations in Aspergillus fumigatus Isolates in Malaysia","volume":"17","author":"Tan","year":"2024","journal-title":"Infect. Drug Resist."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1111\/myc.13593","article-title":"Species distribution and antifungal susceptibility of clinical Aspergillus isolates: A multicentre study in Taiwan, 2016\u20132020","volume":"66","author":"Wang","year":"2023","journal-title":"Mycoses"},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Hsu, T.H., Huang, P.Y., Fan, Y.C., and Sun, P.L. (2022). Azole Resistance and cyp51A Mutation of Aspergillus fumigatus in a Tertiary Referral Hospital in Taiwan. J. Fungi, 8.","DOI":"10.3390\/jof8090908"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1111\/myc.12354","article-title":"Azole-resistant Aspergillus fumigatus isolates carrying TR(3)(4)\/L98H mutations in Taiwan","volume":"58","author":"Wu","year":"2015","journal-title":"Mycoses"},{"key":"ref_99","first-page":"429","article-title":"Prevalence of azole-resistant Aspergillus fumigatus in the environment of Thailand","volume":"55","author":"Tangwattanachuleeporn","year":"2017","journal-title":"Med. Mycol."},{"key":"ref_100","doi-asserted-by":"crossref","unstructured":"Lackner, N., Thome, C., Ofner, D., Joannidis, M., Mayerhofer, T., Arora, R., Samardzic, E., Posch, W., Breitkopf, R., and Lass-Florl, C. (2022). COVID-19 Associated Pulmonary Aspergillosis: Diagnostic Performance, Fungal Epidemiology and Antifungal Susceptibility. J. Fungi, 8.","DOI":"10.3390\/jof8020093"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"100907","DOI":"10.1016\/j.onehlt.2024.100907","article-title":"Pan-azole resistance in clinical Aspergillus fumigatus isolates carrying TR34\/L98H from birds and mammals in Belgium","volume":"19","author":"Debergh","year":"2024","journal-title":"One Health"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"myae055","DOI":"10.1093\/mmy\/myae055","article-title":"Detection of pan-azole resistant Aspergillus fumigatus in horticulture and a composting facility in Belgium","volume":"62","author":"Debergh","year":"2024","journal-title":"Med. Mycol."},{"key":"ref_103","doi-asserted-by":"crossref","unstructured":"Debergh, H., Becker, P., Vercammen, F., Lagrou, K., Haesendonck, R., Saegerman, C., and Packeu, A. (2023). Pulmonary Aspergillosis in Humboldt Penguins-Susceptibility Patterns and Molecular Epidemiology of Clinical and Environmental Aspergillus fumigatus Isolates from a Belgian Zoo, 2017\u20132022. Antibiotics, 12.","DOI":"10.3390\/antibiotics12030584"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"1774","DOI":"10.1016\/j.jiac.2021.08.024","article-title":"Stable prevalence of triazole-resistance in Aspergillus fumigatus complex clinical isolates in a Belgian tertiary care center from 2016 to 2020","volume":"27","author":"Merckx","year":"2021","journal-title":"J. Infect. Chemother."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1128\/JCM.00520-17","article-title":"Culture-Based Methods and Molecular Tools for Azole-Resistant Aspergillus fumigatus Detection in a Belgian University Hospital","volume":"55","author":"Montesinos","year":"2017","journal-title":"J. Clin. Microbiol."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"4569","DOI":"10.1128\/AAC.00233-15","article-title":"Nationwide Surveillance of Azole Resistance in Aspergillus Diseases","volume":"59","author":"Vermeulen","year":"2015","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.3201\/eid3008.240096","article-title":"Environmental Hot Spots and Resistance-Associated Application Practices for Azole-Resistant Aspergillus fumigatus, Denmark, 2020\u20132023","volume":"30","author":"Arendrup","year":"2024","journal-title":"Emerg. Infect. Dis."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1111\/myc.13426","article-title":"Azole resistance in Aspergillus fumigatus. The first 2-year\u2019s Data from the Danish National Surveillance Study, 2018\u20132020","volume":"65","author":"Risum","year":"2022","journal-title":"Mycoses"},{"key":"ref_109","doi-asserted-by":"crossref","unstructured":"Risum, M., Hare, R.K., Gertsen, J.B., Kristensen, L., Johansen, H.K., Helweg-Larsen, J., Abou-Chakra, N., Pressler, T., Skov, M., and Jensen-Fangel, S. (2020). Azole-Resistant Aspergillus fumigatus Among Danish Cystic Fibrosis Patients: Increasing Prevalence and Dominance of TR(34)\/L98H. Front. Microbiol., 11.","DOI":"10.3389\/fmicb.2020.01850"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"2573","DOI":"10.1093\/jac\/dkaa212","article-title":"Revision of EUCAST breakpoints: Consequences for susceptibility of contemporary Danish mould isolates to isavuconazole and comparators","volume":"75","author":"Jorgensen","year":"2020","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_111","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_112","doi-asserted-by":"crossref","first-page":"5096","DOI":"10.1128\/AAC.02855-14","article-title":"First detection of TR46\/Y121F\/T289A and TR34\/L98H alterations in Aspergillus fumigatus isolates from azole-naive patients in Denmark despite negative findings in the environment","volume":"58","author":"Astvad","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_113","doi-asserted-by":"crossref","unstructured":"Godeau, C., Morin-Crini, N., Crini, G., Guillemin, J.P., Voisin, A.S., Dousset, S., and Rocchi, S. (2023). Field-Crop Soils in Eastern France: Coldspots of Azole-Resistant Aspergillus fumigatus. J. Fungi, 9.","DOI":"10.3390\/jof9060618"},{"key":"ref_114","doi-asserted-by":"crossref","unstructured":"Guegan, H., Prat, E., Robert-Gangneux, F., and Gangneux, J.P. (2020). Azole Resistance in Aspergillus fumigatus: A Five-Year Follow Up Experience in a Tertiary Hospital With a Special Focus on Cystic Fibrosis. Front. Cell Infect. Microbiol., 10.","DOI":"10.3389\/fcimb.2020.613774"},{"key":"ref_115","doi-asserted-by":"crossref","unstructured":"Monpierre, L., Desbois-Nogard, N., Valsecchi, I., Bajal, M., Angebault, C., Miossec, C., Botterel, F., and Dannaoui, E. (2021). Azole Resistance in Clinical and Environmental Aspergillus Isolates from the French West Indies (Martinique). J. Fungi, 7.","DOI":"10.3390\/jof7050355"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"106447","DOI":"10.1016\/j.ijantimicag.2021.106447","article-title":"Azole resistance in Aspergillus fumigatus isolates from respiratory specimens in Lyon University Hospitals, France: Prevalence and mechanisms involved","volume":"58","author":"Simon","year":"2021","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.1093\/jac\/dkz144","article-title":"One year prospective survey of azole resistance in Aspergillus fumigatus at a French cystic fibrosis reference centre: Prevalence and mechanisms of resistance","volume":"74","author":"Lavergne","year":"2019","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"32015","DOI":"10.1007\/s11356-018-3177-6","article-title":"Determination of azole fungal residues in soils and detection of Aspergillus fumigatus-resistant strains in market gardens of Eastern France","volume":"25","author":"Rocchi","year":"2018","journal-title":"Environ. Sci. Pollut. Res. Int."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.mycmed.2018.05.007","article-title":"Prospective survey of azole drug resistance among environmental and clinical isolates of Aspergillus fumigatus in a French University hospital during major demolition works","volume":"28","author":"Loeffert","year":"2018","journal-title":"J. Mycol. Med."},{"key":"ref_120","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":"Jeanvoine","year":"2017","journal-title":"J. Appl. Microbiol."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1111\/ina.12436","article-title":"Emergence of Aspergillus fumigatus azole resistance in azole-naive patients with chronic obstructive pulmonary disease and their homes","volume":"28","author":"Dauchy","year":"2018","journal-title":"Indoor Air"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1093\/mmy\/myv029","article-title":"Prospective evaluation of azole resistance in Aspergillus fumigatus clinical isolates in France","volume":"53","author":"Choukri","year":"2015","journal-title":"Med. Mycol."},{"key":"ref_123","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_124","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1093\/jac\/dkq450","article-title":"Low prevalence of resistance to azoles in Aspergillus fumigatus in a French cohort of patients treated for haematological malignancies","volume":"66","author":"Alanio","year":"2011","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1093\/mmy\/myaa045","article-title":"Low rate of azole resistance in cases of avian aspergillosis in Germany","volume":"58","author":"Barber","year":"2020","journal-title":"Med. Mycol."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1093\/jac\/dky147","article-title":"Prevalence and characterization of azole-resistant Aspergillus fumigatus in patients with cystic fibrosis: A prospective multicentre study in Germany","volume":"73","author":"Seufert","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.ijantimicag.2016.10.019","article-title":"Epidemiology of invasive aspergillosis and azole resistance in patients with acute leukaemia: The SEPIA Study","volume":"49","author":"Koehler","year":"2017","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1093\/jac\/dku566","article-title":"Emergence of azole-resistant invasive aspergillosis in HSCT recipients in Germany","volume":"70","author":"Steinmann","year":"2015","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"3513","DOI":"10.1128\/AAC.00167-13","article-title":"cyp51A-Based mechanisms of Aspergillus fumigatus azole drug resistance present in clinical samples from Germany","volume":"57","author":"Bader","year":"2013","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"3181","DOI":"10.1093\/jac\/dkaa316","article-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","volume":"75","author":"Siopi","year":"2020","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1111\/myc.13241","article-title":"Azole resistance in Aspergillus isolates by different types of patients and correlation with environment\u2014An Italian prospective multicentre study (ARiA study)","volume":"64","author":"Prigitano","year":"2021","journal-title":"Mycoses"},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.jgar.2020.01.016","article-title":"Prospective multicentre study on azole resistance in Aspergillus isolates from surveillance cultures in haematological patients in Italy","volume":"22","author":"Prigitano","year":"2020","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.jcf.2016.06.006","article-title":"Triazole resistance in Aspergillus fumigatus isolates from patients with cystic fibrosis in Italy","volume":"16","author":"Prigitano","year":"2017","journal-title":"J. Cyst. Fibros."},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1128\/AAC.02234-15","article-title":"Azole Resistance in Aspergillus fumigatus Clinical Isolates from an Italian Culture Collection","volume":"60","author":"Lazzarini","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"177923","DOI":"10.1016\/j.scitotenv.2024.177923","article-title":"Evaluation of environmental factors related to Aspergillus fumigatus azole resistance in the Netherlands","volume":"958","author":"Cogliati","year":"2024","journal-title":"Sci. Total Environ."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1007\/s11046-024-00850-5","article-title":"Azole Resistance in Veterinary Clinical Aspergillus fumigatus Isolates in the Netherlands","volume":"189","author":"Buil","year":"2024","journal-title":"Mycopathologia"},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1093\/jac\/dkx527","article-title":"Epidemiology of invasive aspergillosis and triazole-resistant Aspergillus fumigatus in patients with haematological malignancies: A single-centre retrospective cohort study","volume":"73","author":"Lestrade","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_138","doi-asserted-by":"crossref","unstructured":"Buil, J.B., Hagen, F., Chowdhary, A., Verweij, P.E., and Meis, J.F. (2018). Itraconazole, Voriconazole, and Posaconazole CLSI MIC Distributions for Wild-Type and Azole-Resistant Aspergillus fumigatus Isolates. J. Fungi, 4.","DOI":"10.3390\/jof4030103"},{"key":"ref_139","first-page":"30300","article-title":"Emerging aspergillosis by azole-resistant Aspergillus fumigatus at an intensive care unit in the Netherlands, 2010 to 2013","volume":"21","author":"Russcher","year":"2016","journal-title":"Eurosurveillance"},{"key":"ref_140","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_141","doi-asserted-by":"crossref","unstructured":"Gorzynska, A., Grzech, A., Mierzwiak, P., Ussowicz, M., Biernat, M., and Nawrot, U. (2023). Quantitative and Qualitative Airborne Mycobiota Surveillance in High-Risk Hospital Environment. Microorganisms, 11.","DOI":"10.3390\/microorganisms11041031"},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.mycmed.2018.12.005","article-title":"Low frequency of itraconazole resistance found among Aspergillus fumigatus originating from poultry farms in Southwest Poland","volume":"29","author":"Nawrot","year":"2019","journal-title":"J. Mycol. Med."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1093\/mmy\/myx012","article-title":"Detection of Polish clinical Aspergillus fumigatus isolates resistant to triazoles","volume":"56","author":"Nawrot","year":"2018","journal-title":"Med. Mycol."},{"key":"ref_144","doi-asserted-by":"crossref","unstructured":"Sabino, R., Goncalves, P., Martins Melo, A., Simoes, D., Oliveira, M., Francisco, M., Viegas, C., Carvalho, D., Martins, C., and Ferreira, T. (2021). Trends on Aspergillus Epidemiology-Perspectives from a National Reference Laboratory Surveillance Program. J. Fungi, 7.","DOI":"10.3390\/jof7010028"},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1080\/09603123.2019.1650903","article-title":"Aspergillus collected in specific indoor settings: Their molecular identification and susceptibility pattern","volume":"31","author":"Simoes","year":"2021","journal-title":"Int. J. Environ. Health Res."},{"key":"ref_146","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","volume":"126","author":"Monteiro","year":"2019","journal-title":"J. Appl. Microbiol."},{"key":"ref_147","doi-asserted-by":"crossref","unstructured":"Pinto, E., Monteiro, C., Maia, M., Faria, M.A., Lopes, V., Lameiras, C., and Pinheiro, D. (2018). Aspergillus Species and Antifungals Susceptibility in Clinical Setting in the North of Portugal: Cryptic Species and Emerging Azoles Resistance in A. fumigatus. Front. Microbiol., 9.","DOI":"10.3389\/fmicb.2018.01656"},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"e13719","DOI":"10.1111\/myc.13719","article-title":"Distribution of Aspergillus species and prevalence of azole resistance in clinical and environmental samples from a Spanish hospital during a three-year study period","volume":"67","author":"Lucio","year":"2024","journal-title":"Mycoses"},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"1170.e1","DOI":"10.1016\/j.cmi.2020.09.042","article-title":"Azole resistance survey on clinical Aspergillus fumigatus isolates in Spain","volume":"27","author":"Escribano","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"e00865-19","DOI":"10.1128\/AAC.00865-19","article-title":"Molecular Identification, Antifungal Susceptibility Testing, and Mechanisms of Azole Resistance in Aspergillus Species Received within a Surveillance Program on Antifungal Resistance in Spain","volume":"63","author":"Medina","year":"2019","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"e00358-18","DOI":"10.1128\/AAC.00358-18","article-title":"Molecular Identification and Susceptibility Testing of Molds Isolated in a Prospective Surveillance of Triazole Resistance in Spain (FILPOP2 Study)","volume":"62","author":"Ayats","year":"2018","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"2815","DOI":"10.1128\/AAC.02487-12","article-title":"Is azole resistance in Aspergillus fumigatus a problem in Spain?","volume":"57","author":"Escribano","year":"2013","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"myad110","DOI":"10.1093\/mmy\/myad110","article-title":"Occurrence of Aspergillus fumigatus azole resistance in soils from Switzerland","volume":"61","author":"Schurch","year":"2023","journal-title":"Med. Mycol."},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"ofab638","DOI":"10.1093\/ofid\/ofab638","article-title":"Distribution of Aspergillus Species and Prevalence of Azole Resistance in Respiratory Samples From Swiss Tertiary Care Hospitals","volume":"9","author":"Ragozzino","year":"2022","journal-title":"Open Forum Infect. Dis."},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"e02088-17","DOI":"10.1128\/AAC.02088-17","article-title":"Azole Resistance of Environmental and Clinical Aspergillus fumigatus Isolates from Switzerland","volume":"62","author":"Riat","year":"2018","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"1894","DOI":"10.1093\/jac\/dkac125","article-title":"Frequency of azole resistance in clinical and environmental strains of Aspergillus fumigatus in Turkey: A multicentre study","volume":"77","author":"Ener","year":"2022","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.jiac.2015.04.012","article-title":"First determination of azole resistance in Aspergillus fumigatus strains carrying the TR34\/L98H mutations in Turkey","volume":"21","author":"Ozmerdiven","year":"2015","journal-title":"J. Infect. Chemother."},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"eadh8839","DOI":"10.1126\/sciadv.adh8839","article-title":"Citizen science reveals landscape-scale exposures to multiazole-resistant Aspergillus fumigatus bioaerosols","volume":"9","author":"Shelton","year":"2023","journal-title":"Sci. Adv."},{"key":"ref_159","doi-asserted-by":"crossref","unstructured":"van der Torre, M.H., Whitby, C., Eades, C.P., Moore, C.B., Novak-Frazer, L., Richardson, M.D., and Rautemaa-Richardson, R. (2020). Absence of Azole Antifungal Resistance in Aspergillus fumigatus Isolated from Root Vegetables Harvested from UK Arable and Horticultural Soils. J. Fungi, 6.","DOI":"10.3390\/jof6040208"},{"key":"ref_160","doi-asserted-by":"crossref","unstructured":"Abdolrasouli, A., Petrou, M.A., Park, H., Rhodes, J.L., Rawson, T.M., Moore, L.S.P., Donaldson, H., Holmes, A.H., Fisher, M.C., and Armstrong-James, D. (2018). Surveillance for Azole-Resistant Aspergillus fumigatus in a Centralized Diagnostic Mycology Service, London, United Kingdom, 1998\u20132017. Front. Microbiol., 9.","DOI":"10.3389\/fmicb.2018.02234"},{"key":"ref_161","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/j.ijantimicag.2018.08.004","article-title":"High prevalence of triazole resistance in clinical Aspergillus fumigatus isolates in a specialist cardiothoracic centre","volume":"52","author":"Abdolrasouli","year":"2018","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_162","doi-asserted-by":"crossref","unstructured":"Tsitsopoulou, A., Posso, R., Vale, L., Bebb, S., Johnson, E., and White, P.L. (2018). Determination of the Prevalence of Triazole Resistance in Environmental Aspergillus fumigatus Strains Isolated in South Wales, UK. Front. Microbiol., 9.","DOI":"10.3389\/fmicb.2018.01395"},{"key":"ref_163","doi-asserted-by":"crossref","unstructured":"Kortenbosch, H.H., van Leuven, F., van den Heuvel, C., Schoustra, S.E., Zwaan, B.J., and Snelders, E. (2024). Catching some air: A method to spatially quantify aerial triazole resistance in Aspergillus fumigatus. Appl. Environ. Microbiol., 90.","DOI":"10.1128\/aem.00271-24"},{"key":"ref_164","doi-asserted-by":"crossref","unstructured":"Simmons, B.C., Rhodes, J., Rogers, T.R., Verweij, P.E., Abdolrasouli, A., Schelenz, S., Hemmings, S.J., Talento, A.F., Griffin, A., and Mansfield, M. (2023). Genomic Epidemiology Identifies Azole Resistance Due to TR(34)\/L98H in European Aspergillus fumigatus Causing COVID-19-Associated Pulmonary Aspergillosis. J. Fungi, 9.","DOI":"10.3390\/jof9111104"},{"key":"ref_165","doi-asserted-by":"crossref","unstructured":"Fraaije, B.A., Atkins, S.L., Santos, R.F., Hanley, S.J., West, J.S., and Lucas, J.A. (2021). Epidemiological Studies of Pan-Azole Resistant Aspergillus fumigatus Populations Sampled during Tulip Cultivation Show Clonal Expansion with Acquisition of Multi-Fungicide Resistance as Potential Driver. Microorganisms, 9.","DOI":"10.3390\/microorganisms9112379"},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"2759","DOI":"10.1093\/jac\/dkz258","article-title":"Prevalence of voriconazole-resistant invasive aspergillosis and its impact on mortality in haematology patients","volume":"74","author":"Mercier","year":"2019","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_167","doi-asserted-by":"crossref","first-page":"e13791","DOI":"10.1111\/myc.13791","article-title":"High Prevalence of Azole-Resistant Aspergillus fumigatus Among Iranian Cystic Fibrosis Patients: Should We Be Concerned?","volume":"67","author":"Bandegani","year":"2024","journal-title":"Mycoses"},{"key":"ref_168","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1089\/mdr.2023.0002","article-title":"Azole-Containing Agar Plates and Antifungal Susceptibility Testing for the Detection of Azole-Resistant Aspergillus Species in Hospital Environmental Samples","volume":"29","author":"Ghazanfari","year":"2023","journal-title":"Microb. Drug Resist."},{"key":"ref_169","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1111\/myc.13535","article-title":"Five-year surveillance study of clinical and environmental Triazole-Resistant Aspergillus fumigatus isolates in Iran","volume":"66","author":"Khojasteh","year":"2023","journal-title":"Mycoses"},{"key":"ref_170","doi-asserted-by":"crossref","unstructured":"Badiee, P., Boekhout, T., Zarei Mahmoudabadi, A., Mohammadi, R., Ayatollahi Mousavi, S.A., Najafzadeh, M.J., Soltani, J., Hashemi, J., Diba, K., and Ghadimi-Moghadam, A. (2022). Multicenter Study of Susceptibility of Aspergillus Species Isolated from Iranian University Hospitals to Seven Antifungal Agents. Microbiol. Spectr., 10.","DOI":"10.1128\/spectrum.02539-21"},{"key":"ref_171","first-page":"994","article-title":"Isolation and Characterization of Clinical Triazole Resistance Aspergillus fumigatus in Iran","volume":"47","author":"Mohammadi","year":"2018","journal-title":"Iran. J. Public Health"},{"key":"ref_172","doi-asserted-by":"crossref","unstructured":"Mohammadi, F., Dehghan, P., Nekoeian, S., and Hashemi, S.J. (2016). Determination of antifungal susceptibility patterns among the environmental isolates of Aspergillus fumigatus in Iran. Adv. Biomed. Res., 5.","DOI":"10.4103\/2277-9175.187410"},{"key":"ref_173","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_174","doi-asserted-by":"crossref","first-page":"2611","DOI":"10.1093\/jac\/dkae267","article-title":"In vitro activity of olorofim against 507 filamentous fungi including antifungal drug-resistant strains at a tertiary laboratory in Australia: 2020\u20132023","volume":"79","author":"Halliday","year":"2024","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_175","doi-asserted-by":"crossref","first-page":"2347","DOI":"10.1093\/jac\/dky187","article-title":"Surveillance for azole resistance in clinical and environmental isolates of Aspergillus fumigatus in Australia and cyp51A homology modelling of azole-resistant isolates","volume":"73","author":"Talbot","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_176","first-page":"41","article-title":"The emergence of azole resistance in Aspergillus fumigatus complex in New Zealand","volume":"134","author":"McKinney","year":"2021","journal-title":"N. Z. Med. J."},{"key":"ref_177","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.pathol.2020.09.030","article-title":"Antifungal susceptibility of clinical mould isolates in New Zealand, 2001\u20132019","volume":"53","author":"Morris","year":"2021","journal-title":"Pathology"},{"key":"ref_178","first-page":"100888","article-title":"Invasive aspergillosis in adult patients in Australia and New Zealand: 2017\u20132020","volume":"40","author":"Tio","year":"2023","journal-title":"Lancet Reg. Health\u2013West. Pac."},{"key":"ref_179","doi-asserted-by":"crossref","unstructured":"Pfaller, M.A., Carvalhaes, C.G., Deshpande, L.M., Rhomberg, P.R., and Castanheira, M. (2023). In Vitro Activity of Isavuconazole and Other Mould-Active Azoles against Aspergillus fumigatus with and without CYP51 Alterations. J. Fungi, 9.","DOI":"10.3390\/jof9060608"},{"key":"ref_180","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1038\/s41429-021-00431-4","article-title":"Antifungal susceptibilities of opportunistic filamentous fungal pathogens from the Asia and Western Pacific Region: Data from the SENTRY Antifungal Surveillance Program (2011\u20132019)","volume":"74","author":"Pfaller","year":"2021","journal-title":"J. Antibiot."},{"key":"ref_181","doi-asserted-by":"crossref","first-page":"e00906-17","DOI":"10.1128\/AAC.00906-17","article-title":"Monitoring Antifungal Resistance in a Global Collection of Invasive Yeasts and Molds: Application of CLSI Epidemiological Cutoff Values and Whole-Genome Sequencing Analysis for Detection of Azole Resistance in Candida albicans","volume":"61","author":"Castanheira","year":"2017","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_182","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.diagmicrobio.2016.02.009","article-title":"Antifungal susceptibility patterns of a global collection of fungal isolates: Results of the SENTRY Antifungal Surveillance Program (2013)","volume":"85","author":"Castanheira","year":"2016","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_183","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1038\/ja.2015.29","article-title":"Antifungal susceptibilities of Candida, Cryptococcus neoformans and Aspergillus fumigatus from the Asia and Western Pacific region: Data from the SENTRY antifungal surveillance program (2010\u20132012)","volume":"68","author":"Pfaller","year":"2015","journal-title":"J. Antibiot."},{"key":"ref_184","doi-asserted-by":"crossref","first-page":"12","DOI":"10.3382\/ps.2013-03541","article-title":"Mutations in the Cyp51A gene and susceptibility to itraconazole in Aspergillus fumigatus isolated from avian farms in France and China","volume":"93","author":"Wang","year":"2014","journal-title":"Poult. Sci."},{"key":"ref_185","doi-asserted-by":"crossref","first-page":"4465","DOI":"10.1128\/AAC.00185-11","article-title":"Azole resistance in Aspergillus fumigatus isolates from the ARTEMIS global surveillance study is primarily due to the TR\/L98H mutation in the cyp51A gene","volume":"55","author":"Lockhart","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_186","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1128\/JCM.02136-10","article-title":"Use of epidemiological cutoff values to examine 9-year trends in susceptibility of Aspergillus species to the triazoles","volume":"49","author":"Pfaller","year":"2011","journal-title":"J. Clin. Microbiol."},{"key":"ref_187","doi-asserted-by":"crossref","first-page":"3251","DOI":"10.1128\/JCM.00536-10","article-title":"Wild-type MIC distributions and epidemiological cutoff values for the triazoles and six Aspergillus spp. for the CLSI broth microdilution method (M38-A2 document)","volume":"48","author":"Diekema","year":"2010","journal-title":"J. Clin. Microbiol."},{"key":"ref_188","doi-asserted-by":"crossref","first-page":"3142","DOI":"10.1128\/JCM.00940-09","article-title":"Wild-type MIC distribution and epidemiological cutoff values for Aspergillus fumigatus and three triazoles as determined by the Clinical and Laboratory Standards Institute broth microdilution methods","volume":"47","author":"Pfaller","year":"2009","journal-title":"J. Clin. Microbiol."},{"key":"ref_189","doi-asserted-by":"crossref","first-page":"100115","DOI":"10.1016\/j.simyco.2021.100115","article-title":"Aspergillus fumigatus and aspergillosis: From basics to clinics","volume":"100","author":"Arastehfar","year":"2021","journal-title":"Stud. Mycol."},{"key":"ref_190","doi-asserted-by":"crossref","unstructured":"Hagiwara, D., Watanabe, A., Kamei, K., and Goldman, G.H. (2016). Epidemiological and Genomic Landscape of Azole Resistance Mechanisms in Aspergillus Fungi. Front. Microbiol., 7.","DOI":"10.3389\/fmicb.2016.01382"},{"key":"ref_191","doi-asserted-by":"crossref","unstructured":"Berger, S., El Chazli, Y., Babu, A.F., and Coste, A.T. (2017). Azole Resistance in Aspergillus fumigatus: A Consequence of Antifungal Use in Agriculture?. Front. Microbiol., 8.","DOI":"10.3389\/fmicb.2017.01024"},{"key":"ref_192","doi-asserted-by":"crossref","first-page":"e00791-17","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":"Zhang","year":"2017","journal-title":"mBio"},{"key":"ref_193","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1038\/nature07528","article-title":"Discovery of a sexual cycle in the opportunistic fungal pathogen Aspergillus fumigatus","volume":"457","author":"Fuller","year":"2009","journal-title":"Nature"},{"key":"ref_194","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.3201\/eid2410.180730","article-title":"Non-cyp51A Azole-Resistant Aspergillus fumigatus Isolates with Mutation in HMG-CoA Reductase","volume":"24","author":"Hagiwara","year":"2018","journal-title":"Emerg. Infect. Dis."},{"key":"ref_195","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1128\/JCM.00064-07","article-title":"Multilocus sequence typing of the pathogenic fungus Aspergillus fumigatus","volume":"45","author":"Bain","year":"2007","journal-title":"J. Clin. Microbiol."},{"key":"ref_196","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.1080\/13693780802382244","article-title":"MLST versus microsatellites for typing Aspergillus fumigatus isolates","volume":"47","author":"Klaassen","year":"2009","journal-title":"Med. Mycol."},{"key":"ref_197","doi-asserted-by":"crossref","unstructured":"Garcia-Rubio, R., Escribano, P., Gomez, A., Guinea, J., and Mellado, E. (2018). Comparison of Two Highly Discriminatory Typing Methods to Analyze Aspergillus fumigatus Azole Resistance. Front. Microbiol., 9.","DOI":"10.3389\/fmicb.2018.01626"},{"key":"ref_198","doi-asserted-by":"crossref","unstructured":"Gomez Londono, L.F., and Brewer, M.T. (2023). Detection of azole-resistant Aspergillus fumigatus in the environment from air, plant debris, compost, and soil. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0282499"},{"key":"ref_199","doi-asserted-by":"crossref","first-page":"e00843-20","DOI":"10.1128\/JCM.00843-20","article-title":"Rapid Detection of Azole-Resistant Aspergillus fumigatus in Clinical and Environmental Isolates by Use of a Lab-on-a-Chip Diagnostic System","volume":"58","author":"Yu","year":"2020","journal-title":"J. Clin. Microbiol."},{"key":"ref_200","unstructured":"(2018). AsperGenius\u00ae: A multiplex Real Time PCR Assay for the Detection of Aspergillus fumigatus and Identification of Azole Resistance Markers, PathoNostics."},{"key":"ref_201","doi-asserted-by":"crossref","unstructured":"Rocchi, S., Sewell, T.R., Valot, B., Godeau, C., Laboissiere, A., Millon, L., and Fisher, M.C. (2021). Molecular Epidemiology of Azole-Resistant Aspergillus fumigatus in France Shows Patient and Healthcare Links to Environmentally Occurring Genotypes. Front. Cell Infect. Microbiol., 11.","DOI":"10.3389\/fcimb.2021.729476"},{"key":"ref_202","doi-asserted-by":"crossref","unstructured":"Gonzalez-Jimenez, I., Lucio, J., Menendez-Fraga, M.D., Mellado, E., and Pelaez, T. (2021). Hospital Environment as a Source of Azole-Resistant Aspergillus fumigatus Strains with TR34\/L98H and G448S Cyp51A Mutations. J. Fungi, 7.","DOI":"10.3390\/jof7010022"},{"key":"ref_203","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1111\/1462-2920.14055","article-title":"Emergence of azole resistant Aspergillus fumigatus and One Health: Time to implement environmental stewardship","volume":"20","author":"Chowdhary","year":"2018","journal-title":"Environ. Microbiol."},{"key":"ref_204","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1007\/s40588-022-00181-3","article-title":"Emerging Fungal Infections: From the Fields to the Clinic, Resistant Aspergillus fumigatus and Dermatophyte Species: A One Health Perspective on an Urgent Public Health Problem","volume":"9","author":"Langfeldt","year":"2022","journal-title":"Curr. Clin. Microbiol. Rep."},{"key":"ref_205","doi-asserted-by":"crossref","unstructured":"Melo, A.M., Stevens, D.A., Tell, L.A., Verissimo, C., Sabino, R., and Xavier, M.O. (2020). Aspergillosis, Avian Species and the One Health Perspective: The Possible Importance of Birds in Azole Resistance. Microorganisms, 8.","DOI":"10.3390\/microorganisms8122037"},{"key":"ref_206","doi-asserted-by":"crossref","first-page":"280","DOI":"10.3390\/clinpract14010022","article-title":"Risk Factors and Environmental Preventive Actions for Aspergillosis in Patients with Hematological Malignancies","volume":"14","author":"Morales","year":"2024","journal-title":"Clin. Pract."},{"key":"ref_207","doi-asserted-by":"crossref","first-page":"e24","DOI":"10.1093\/cid\/cir771","article-title":"Outbreak of invasive aspergillosis after major heart surgery caused by spores in the air of the intensive care unit","volume":"54","author":"Pelaez","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_208","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/BF01570065","article-title":"Fungal colonization of air filters for use in heating, ventilating, and air conditioning (HVAC) systems","volume":"14","author":"Simmons","year":"1995","journal-title":"J. Ind. Microbiol."},{"key":"ref_209","doi-asserted-by":"crossref","first-page":"3712","DOI":"10.1128\/AEM.67.8.3712-3715.2001","article-title":"Effectiveness of germicidal UV radiation for reducing fungal contamination within air-handling units","volume":"67","author":"Levetin","year":"2001","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_210","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1093\/cid\/civ297","article-title":"Review of fungal outbreaks and infection prevention in healthcare settings during construction and renovation","volume":"61","author":"Kanamori","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref_211","unstructured":"Lesnik, B., and Crumbling, D. (2024, December 12). Guidelines for Preparing Sampling and Analysis Plans (SAPS) Using Systematic Planning and Performance-Based Measurement System (PBMS), Available online: https:\/\/www.epa.gov\/hw-sw846\/guidelines-preparing-sampling-and-analysis-plans-saps-using-systematic-planning-and."},{"key":"ref_212","unstructured":"Sehulster, L., and Chinn, R.Y.W. (2003). Guidelines for Environmental Infection Control in Health-Care Facilities, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention."},{"key":"ref_213","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1017\/ice.2021.285","article-title":"Surveillance practices and air-sampling strategies to address healthcare-associated invasive mold infections in Society for Healthcare Epidemiology of America (SHEA) Research Network hospitals-United States, 2020","volume":"43","author":"Gold","year":"2022","journal-title":"Infect. Control. Hosp. Epidemiol."},{"key":"ref_214","doi-asserted-by":"crossref","first-page":"S199","DOI":"10.1080\/13693780802709073","article-title":"Preventing healthcare-associated Aspergillus infections: Review of recent CDC\/HICPAC recommendations","volume":"47","author":"Weber","year":"2009","journal-title":"Med. Mycol."},{"key":"ref_215","doi-asserted-by":"crossref","unstructured":"Marekovic, I. (2023). What\u2019s New in Prevention of Invasive Fungal Diseases during Hospital Construction and Renovation Work: An Overview. J. Fungi, 9.","DOI":"10.3390\/jof9020151"},{"key":"ref_216","unstructured":"Ducel, G., Fabry, J., and Nicolle, L. (2002). Prevention of Hospital-Acquired Infections: A Practical Guide, WHO Department of Communicable Disease Surveillance and Response."},{"key":"ref_217","doi-asserted-by":"crossref","first-page":"151716","DOI":"10.1016\/j.scitotenv.2021.151716","article-title":"A systematic review of outdoor airborne fungal spore seasonality across Europe and the implications for health","volume":"818","author":"Douglas","year":"2022","journal-title":"Sci. Total Environ."},{"key":"ref_218","doi-asserted-by":"crossref","unstructured":"Priyamvada, H., Singh, R.K., Akila, M., Ravikrishna, R., Verma, R.S., and Gunthe, S.S. (2017). Seasonal variation of the dominant allergenic fungal aerosols\u2014One year study from southern Indian region. Sci. Rep., 7.","DOI":"10.1038\/s41598-017-11727-7"},{"key":"ref_219","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1093\/intqhc\/mzm062","article-title":"Development of medical checklists for improved quality of patient care","volume":"20","author":"Hales","year":"2008","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_220","unstructured":"World Health Organization (2023). WHO STEPS Surveillance: Planning and Set Up, World Health Organization."},{"key":"ref_221","doi-asserted-by":"crossref","first-page":"3325","DOI":"10.1093\/jac\/dkx319","article-title":"Multicentre validation of 4-well azole agar plates as a screening method for detection of clinically relevant azole-resistant Aspergillus fumigatus","volume":"72","author":"Arendrup","year":"2017","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_222","doi-asserted-by":"crossref","unstructured":"Lion, T. (2017). Culture-Based Techniques. Human Fungal Pathogen Identification: Methods and Protocols, Springer.","DOI":"10.1007\/978-1-4939-6515-1"},{"key":"ref_223","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1093\/cid\/ciad141","article-title":"Clinical Impact of Polymerase Chain Reaction-Based Aspergillus and Azole Resistance Detection in Invasive Aspergillosis: A Prospective Multicenter Study","volume":"77","author":"Huygens","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_224","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1007\/s12281-023-00471-3","article-title":"Maximizing Yield and Speed of Fungal Pathogen Identification with Molecular Testing Performed Directly on Patient Specimens","volume":"17","author":"Lieberman","year":"2023","journal-title":"Curr. Fungal Infect. Rep."},{"key":"ref_225","doi-asserted-by":"crossref","unstructured":"Anjum, M.F., Zankari, E., and Hasman, H. (2017). Molecular Methods for Detection of Antimicrobial Resistance. Microbiol. Spectr., 5.","DOI":"10.1128\/microbiolspec.ARBA-0011-2017"},{"key":"ref_226","unstructured":"Guinea, J., Meletiadis, J., Arikan-Akdagli, S., Muehlethaler, K., Kahlmeter, G., and Arendrup, M.C. (2022). EUCAST E.Def 9.4 March 2022: Method for the Determination of Broth Dilution Minimum Inhibitory Concentrations of Antifungal Agents for Conidia Forming Moulds, EUCAST."},{"key":"ref_227","unstructured":"Alexander, B.D., Procop, G.W., Dufresne, P., Espinel-Ingroff, A., Fuller, J., Ghannoum, M.A., Hanson, K.E., Holliday, D., Holliday, N.M., and Ostrosky-Zeichner, L. (2017). CLSI M38Ed3E: Reference Method for Broth Dilution Antifungal Susceptibility Testing of Filamentous Fungi, Clinical and Laboratory Standards Institute. [3rd ed.]."},{"key":"ref_228","unstructured":"European Committee on Antimicrobial Susceptibility Testing (2024). Overview of Antifungal ECOFFs and Clinical Breakpoints for Yeasts, Moulds and Dermatophytes Using the EUCAST E.Def 7.4, E.Def 9.4 and E.Def 11.0 Procedures, EUCAST."},{"key":"ref_229","unstructured":"Clinical and Laboratory Standards Institute (2022). Epidemiological Cutoff Values for Antifungal Susceptibility Testing, Clinical and Laboratory Standards Institute. [4th ed.]. CLSI Supplement M57S."},{"key":"ref_230","unstructured":"Clinical and Laboratory Standards Institute (2022). Performance Standards for Antifungal Susceptibility Testing of Filamentous Fungi, Clinical and Laboratory Standards Institute. [3rd ed.]."},{"key":"ref_231","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1128\/CMR.00047-06","article-title":"Setting and revising antibacterial susceptibility breakpoints","volume":"20","author":"Turnidge","year":"2007","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_232","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.riam.2016.04.001","article-title":"The role of epidemiological cutoff values (ECVs\/ECOFFs) in antifungal susceptibility testing and interpretation for uncommon yeasts and moulds","volume":"33","author":"Turnidge","year":"2016","journal-title":"Rev. Iberoam. Micol."},{"key":"ref_233","doi-asserted-by":"crossref","first-page":"e0120724","DOI":"10.1128\/jcm.01207-24","article-title":"Use of voriconazole to predict susceptibility and resistance to isavuconazole for Aspergillus fumigatus using CLSI methods and interpretive criteria","volume":"20","author":"Winkler","year":"2024","journal-title":"J. Clin. Microbiol."},{"key":"ref_234","unstructured":"Meletiadis, J., Guinea, J., Arikan-Akdagli, S., Friberg, N., Kahlmeter, G., and Arendrup, M.C. (2022). EUCAST E.Def 10.2 June 2022: Screening Method for the Detection of Azole and Echinocandin Resistance in Aspergillus spp, EUCAST."},{"key":"ref_235","unstructured":"Centers for Disease Control Prevention (2024, December 31). Laboratory Azole-Resistant Aspergillus fumigatus Screening, Available online: https:\/\/www.cdc.gov\/aspergillosis\/php\/azole-resistant-aspergillus\/index.html."},{"key":"ref_236","doi-asserted-by":"crossref","unstructured":"Paranos, P., Espinel-Ingroff, A., and Meletiadis, J. (2024). Commercial Methods for Antifungal Susceptibility Testing of Saprophytic Molds: Can They Be Used to Detect Resistance?. J. Fungi, 10.","DOI":"10.3390\/jof10030214"},{"key":"ref_237","doi-asserted-by":"crossref","unstructured":"Naicker, S., Mohanlall, V., Ngubane, S., Mellem, J., and McHunu, N.P. (2023). Phenotypic Array for Identification and Screening of Antifungals against Aspergillus Isolates from Respiratory Infections in KwaZulu Natal, South Africa. J. Fungi, 9.","DOI":"10.3390\/jof9060616"},{"key":"ref_238","doi-asserted-by":"crossref","unstructured":"Zhang, J., Debets, A.J.M., Verweij, P.E., and Schoustra, S.E. (2021). Selective Flamingo Medium for the Isolation of Aspergillus fumigatus. Microorganisms, 9.","DOI":"10.3390\/microorganisms9061155"},{"key":"ref_239","doi-asserted-by":"crossref","first-page":"3528","DOI":"10.1093\/jac\/dkw323","article-title":"PCR-based detection of Aspergillus fumigatus Cyp51A mutations on bronchoalveolar lavage: A multicentre validation of the AsperGenius assay(R) in 201 patients with haematological disease suspected for invasive aspergillosis","volume":"71","author":"Chong","year":"2016","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_240","doi-asserted-by":"crossref","unstructured":"Lofgren, L.A., Ross, B.S., Cramer, R.A., and Stajich, J.E. (2022). The pan-genome of Aspergillus fumigatus provides a high-resolution view of its population structure revealing high levels of lineage-specific diversity driven by recombination. PLoS Biol., 20.","DOI":"10.1371\/journal.pbio.3001890"},{"key":"ref_241","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.jmii.2021.11.008","article-title":"Development and clinical implications of a novel CRISPR-based diagnostic test for pulmonary Aspergillus fumigatus infection","volume":"55","author":"Li","year":"2022","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_242","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.jmoldx.2018.10.004","article-title":"Rapid and Sensitive Detection of Azole-Resistant Aspergillus fumigatus by Tandem Repeat Loop-Mediated Isothermal Amplification","volume":"21","author":"Yu","year":"2019","journal-title":"J. Mol. Diagn."},{"key":"ref_243","doi-asserted-by":"crossref","unstructured":"Trabasso, P., Matsuzawa, T., Arai, T., Hagiwara, D., Mikami, Y., Moretti, M.L., and Watanabe, A. (2021). Development and validation of LAMP primer sets for rapid identification of Aspergillus fumigatus carrying the cyp51A TR(46) azole resistance gene. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-96651-7"},{"key":"ref_244","doi-asserted-by":"crossref","unstructured":"Bani, A., Whitby, C., Colbeck, I., Dumbrell, A.J., and Ferguson, R.M.W. (2024). Rapid In-Field Detection of Airborne Pathogens Using Loop-Mediated Isothermal Amplification (LAMP). Microorganisms, 12.","DOI":"10.3390\/microorganisms12122578"},{"key":"ref_245","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.cmi.2021.06.005","article-title":"Detection of azole resistance in Aspergillus fumigatus complex isolates using MALDI-TOF mass spectrometry","volume":"28","author":"Zvezdanova","year":"2022","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_246","doi-asserted-by":"crossref","unstructured":"Gilbert, G., and Kerridge, I. (2019). Hospital Infection Prevention and Control (IPC) and Antimicrobial Stewardship Programmes. Ethics and Drug Resistance: Collective Responsibility for Global Public Health, Springer International Publishing.","DOI":"10.1007\/978-3-030-27874-8_6"},{"key":"ref_247","first-page":"577","article-title":"Azole-resistant Aspergillus fumigatus: A global phenomenon originating in the environment?","volume":"49","author":"Jeanvoine","year":"2019","journal-title":"Med. Mal. Infect."},{"key":"ref_248","unstructured":"World Health Organization (2024). Surveillance of Health Care-Associated Infections at National and Facility Levels: Practical Handbook, World Health Organization."},{"key":"ref_249","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1016\/j.ajic.2022.04.007","article-title":"Recommendations for change in infection prevention programs and practice","volume":"50","author":"Garcia","year":"2022","journal-title":"Am. J. Infect. Control"},{"key":"ref_250","unstructured":"(2024, December 22). ISO 9001:2015(en); Quality Management Systems\u2014Requirements. Available online: https:\/\/www.iso.org\/obp\/ui\/#iso:std:iso:9001:ed-5:v1:en."},{"key":"ref_251","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1093\/mmy\/myab007","article-title":"One year later: The effect of changing azole-treated bulbs for organic tulips bulbs in hospital environment on the azole-resistant Aspergillus fumigatus rate","volume":"59","author":"Rocchi","year":"2021","journal-title":"Med. Mycol."},{"key":"ref_252","unstructured":"Government of Japan (2023). National Action Plan on Antimicrobial Resistance (AMR) 2023\u20132027, The Government of Japan."},{"key":"ref_253","doi-asserted-by":"crossref","unstructured":"Dladla, M., Gyzenhout, M., Marias, G., and Ghosh, S. (2024). Azole resistance in Aspergillus fumigatus-comprehensive review. Arch. Microbiol., 206.","DOI":"10.1007\/s00203-024-04026-z"}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/11\/2\/96\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:36:05Z","timestamp":1759919765000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/11\/2\/96"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,25]]},"references-count":253,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jof11020096"],"URL":"https:\/\/doi.org\/10.3390\/jof11020096","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,25]]}}}