In a multicenter study, we determined a prevalence rate of 4% for azole-resistant Aspergillus fumigatus in Taiwan. Resistance emerged mainly from the environment (TR34/L98H, TR34/L98H/S297T/F495I, and TR46/Y121F/T289A mutations) but occasionally during azole treatment. A high mortality rate observed for azole-resistant aspergillosis necessitates diagnostic stewardship in healthcare and antifungal stewardship in the environment.
Keywords: Aspergillus fumigatus; HMG-CoA reductase; TR34/L98H; TR46/Y121F/T289A; Taiwan; antimicrobial resistance; azole resistance; azole use; cdr1B; clinical isolates; cyp51A; environments; fungi; humans.