Meta-analysis of antifungal resistance patterns of Aspergillus species in Iran

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-05-22 DOI:10.1016/j.jiph.2025.102838

Ibrahim Bahrami Mianrood , Farid Javandoust Gharebagh , Sadegh Khodavaisy , Maryam Ahmadian , Ilad Alavi Darazam

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引用次数: 0

Abstract

Background and objectives

Aspergillus infection has several manifestations, ranging from noninvasive aspergillosis to invasive pulmonary and cerebral aspergillosis. Prophylaxis and treatment regimens for aspergillosis rely on triazoles, echinocandins, and polyenes, with specific efficacies, complications, and resistance patterns. Drug selection presents challenges, including differences in resistance rates, drug interactions, and concerns about side effects with long-term use. Aspergillus resistance to antifungal agents is an international concern and has shown an increasing trend. Each region worldwide has a resistance pattern affecting prevention and treatment regimens.

Methods

This meta-analysis started with a systematic search through PubMed, Scopus, Web of Science, Scientific Information Database (SID) and MagIran based on a combination of these keywords with “AND/OR” operators: Aspergillus/Aspergilli, resistance/resistant, susceptibility/susceptible, drug, antimicrobial(s), antifungal(s) and Iran. Search results are reported on the basis of the Preferred Reporting Items for Systematic and Meta-analyses (PRISMA).

Results

The pooled resistance rates of Aspergillus fumigatus were 6.97 % for amphotericin B, 1.40 % for caspofungin, 17.61 % for itraconazole, 4.56 % for posaconazole, and 14.68 % for voriconazole. The percentage of resistance in Aspergillus flavus was 13.16 % for amphotericin B, 13.09 % for caspofungin, 10.19 % for itraconazole, 1.23 % for posaconazole, and 0.58 % for voriconazole.

Conclusion

Our findings highlight the need for antifungal resistance surveillance in Iran. Treatment decisions should consider resistance patterns, host factors, and drug pharmacokinetics. We recommend establishing antifungal stewardship programs to develop evidence-based guidelines. Based on our findings, we suggest posaconazole or voriconazole for A. fumigatus and A. flavus, amphotericin B as alternative therapy, and caspofungin as salvage therapy.

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伊朗曲霉种抗真菌抗性模式荟萃分析

背景与目的曲霉感染有多种表现，从非侵袭性曲霉病到侵袭性肺曲霉病和脑曲霉病。曲霉病的预防和治疗方案依赖于三唑、棘白菌素和多烯，具有特定的疗效、并发症和耐药模式。药物选择面临挑战，包括耐药率差异、药物相互作用以及对长期使用副作用的担忧。曲霉对抗真菌药物的耐药性是一个国际关注的问题，并呈上升趋势。世界上每个区域都有影响预防和治疗方案的耐药性模式。方法系统检索PubMed、Scopus、Web of Science、Scientific Information Database （SID）和MagIran，检索关键词为Aspergillus/Aspergilli、resistance/resistant、susceptibility/易感、drug、antimicrobial(s)、antifungi (s)和Iran。搜索结果的报告是基于首选报告项目的系统和荟萃分析（PRISMA）。结果烟曲霉对两性霉素B的总耐药率分别为6.97 %、1.40 %、伊曲康唑17.61 %、泊沙康唑4.56 %、伏立康唑14.68 %。黄曲霉对两性霉素B的耐药率分别为13.16 %、13.09 %、伊曲康唑10.19 %、泊沙康唑1.23 %、伏立康唑0.58 %。结论本研究结果强调了在伊朗开展抗真菌药物耐药性监测的必要性。治疗决定应考虑耐药模式、宿主因素和药物药代动力学。我们建议建立抗真菌管理计划，以制定循证指南。根据我们的研究结果，我们建议泊沙康唑或伏立康唑治疗烟曲霉和黄曲霉，两性霉素B作为替代治疗，卡泊芬津作为补救性治疗。

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.