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00925njm 22002777a 4500 dc Zoran, Tamara author Sartori, Bettina author Sappl, Laura author Aigner, Maria author Sánchez-Reus, Ferran author Rezusta, Antonio author Chowdhary, Anuradha author Taj-Aldeen, Saad J author Arendrup, Maiken Cavling author Oliveri, Salvatore author Kontoyiannis, Dimitrios P author Alastruey-Izquierdo, Ana author Lagrou, Katrien author Cascio, Giuliana Lo author Meis, Jacques F author Buzina, Walter author Farina, Claudio author Drogari-Apiranthitou, Miranda author Grancini, Anna author Tortorano, Anna M author Willinger, Birgit author Hamprecht, Axel author Johnson, Elizabeth author Klingspor, Lena author Arsic-Arsenijevic, Valentina author Cornely, Oliver A author Meletiadis, Joseph author Prammer, Wolfgang author Tullio, Vivian author Vehreschild, Jörg-Janne author Trovato, Laura author Lewis, Russell E author Segal, Esther author Rath, Peter-Michael author Hamal, Petr author Rodriguez-Iglesias, Manuel author Roilides, Emmanuel author Arikan-Akdagli, Sevtap author Chakrabarti, Arunaloke author Colombo, Arnaldo L author Fernández, Mariana S author Martín-Gómez, María Teresa author Badali, Hamid author Petrikkos, Georgios author Klimko, Nikolai author Heimann, Sebastian M author Uzun, Omrum author Roudbary, Maryam author de la Fuente, Sonia author Houbraken, Jos author Risslegger, Brigitte author Lass-Flörl, Cornelia author Lackner, Michaela author 2018 Objectives: Invasive mold infections associated with Aspergillus species are a significant cause of mortality in immunocompromised patients. The most frequently occurring aetiological pathogens are members of the Aspergillus section Fumigati followed by members of the section Terrei. The frequency of Aspergillus terreus and related (cryptic) species in clinical specimens, as well as the percentage of azole-resistant strains remains to be studied. Methods: A global set (n = 498) of A. terreus and phenotypically related isolates was molecularly identified (beta-tubulin), tested for antifungal susceptibility against posaconazole, voriconazole, and itraconazole, and resistant phenotypes were correlated with point mutations in the cyp51A gene. Results: The majority of isolates was identified as A. terreus (86.8%), followed by A. citrinoterreus (8.4%), A. hortai (2.6%), A. alabamensis (1.6%), A. neoafricanus (0.2%), and A. floccosus (0.2%). One isolate failed to match a known Aspergillus sp., but was found most closely related to A. alabamensis. According to EUCAST clinical breakpoints azole resistance was detected in 5.4% of all tested isolates, 6.2% of A. terreus sensu stricto (s.s.) were posaconazole-resistant. Posaconazole resistance differed geographically and ranged from 0% in the Czech Republic, Greece, and Turkey to 13.7% in Germany. In contrast, azole resistance among cryptic species was rare 2 out of 66 isolates and was observed only in one A. citrinoterreus and one A. alabamensis isolate. The most affected amino acid position of the Cyp51A gene correlating with the posaconazole resistant phenotype was M217, which was found in the variation M217T and M217V. Conclusions:Aspergillus terreus was most prevalent, followed by A. citrinoterreus. Posaconazole was the most potent drug against A. terreus, but 5.4% of A. terreus sensu stricto showed resistance against this azole. In Austria, Germany, and the United Kingdom posaconazole-resistance in all A. terreus isolates was higher than 10%, resistance against voriconazole was rare and absent for itraconazole. Front Microbiol. 2018 Mar 28;9:516. 10.3389/fmicb.2018.00516 1664-302X Frontiers in microbiology 29643840 http://hdl.handle.net/20.500.12105/7628 Aspergillus section Terrei Cyp51A alterations Azoles Cryptic species Susceptibility profiles Azole-Resistance in Aspergillus terreus and Related Species: An Emerging Problem or a Rare Phenomenon?