Arshad Hussain,1 Yijing Wang,1 Emily Mo,2 Muhammad Nadeem Khan,3 Qiangqiang Zhang,1 Li Li,1 Junhao Zhu,1 Min Zhu1 

1Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China; 3Department of Cell Biology & Genetics, Shantou University Medical College, Shantou, People’s Republic of China

Correspondence: Min Zhu, Email zhuminhs@fudan.edu.cn

Background and Aim: Infection caused by Aspergillus species poses a growing global concern, yet their prevalence in Southeast China lacks comprehensive documentation. This retrospective analysis aims to elucidate the epidemiological role and antifungal susceptibilities of Aspergillus species at Huashan Hospital of Fudan University, Shanghai, China.
Methods: Data spanning from 2018 to 2022, encompassing demographic, clinical, and laboratory information on Aspergillus species isolates were analyzed. The isolates were subjected to susceptibility testing using YeastOneTM broth microdilution system.
Results: A total of 253 Aspergillus isolates were identified, with A. fumigatus (57.71%) being the predominant species, followed by A. niger (26.88%), A. flavus (10.67%), and A. terreus (3.95%). Notably, the highest number of isolates originated from the Department of Infectious Disease (28.06%), with sputum (54.94%) being the primary source of isolation, where A. fumigatus was the dominant species. Gastrointestinal disorder (23.90%), hepatic disorder (9.09%), and diabetes (8.30%) were identified as the most prevalent underlying conditions, with A. fumigatus being the most abundant species in each case, accounting for 65.08%, 82.60%, and 73.91%, respectively, followed by A. flavus. Non-wild-type (NWT) Aspergillus isolates exhibited higher resistance against amphotericin B (AMB) compared to triazoles. Specifically, A. fumigatus showed greater resistance to AMB, with only 23.28% of isolates being susceptible, while the majority of isolates were susceptible to triazoles like itraconazole (ITR) and posaconazole (POS). POS demonstrated the highest efficacy against all species. Sequencing revealed mutations in the promoter region of the cyp51A gene and at positions Y121F and E247K in A, fumigatus which confer resistance to ITR, voriconazole (VRC), and POS.
Conclusion: These findings contribute to a better understanding of the epidemiology and antifungal resistance pattern of Aspergillus species in the region, providing valuable insights for the management of Aspergillus-related infections.

Keywords: Aspergillus, antifungal susceptibility, epidemiology