Rates of azole resistance in aspergillosis: a worldwide overview.

PURPOSE OF REVIEW: Triazole-resistant Aspergillus fumigatus is a growing clinical problem. Resistance can develop with clinical exposure and with environmental exposure to azole and azole-like compounds used as fungicides in agriculture. The purpose of this review is to provide an update of our current understanding of the epidemiology and prevalence of this emerging problem. RECENT FINDINGS: Triazole-resistant A. fumigatus is now a worldwide problem. Resistant isolates have been found in clinical and environmental samples collected from many countries on all inhabitable continents. The most commonly identified mechanisms of resistance are those associated with environmental exposure. Although the prevalence of triazole-resistant Aspergillus has been most extensively studied in Europe, hotspots have emerged in other countries, both in the environment and in clinical settings. However, the true extent of the problem is not well understood secondary to limitations with small studies of limited duration and the lack of comprehensive surveillance programs. SUMMARY: Triazole-resistant A. fumigatus is an emerging issue both clinically and in the environment. Greater attention and more resources are needed to better understand the extent of the problem.