The emergence of decreased activity of amphotericin B and voriconazole against clinical isolates of Aspergillus species: a subtropical region of the Middle East

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Robabeh Dehghani
Shirin Mohammadi
Hossein Zarrinfar
Lida Jarahi
Mohammad Javad Najafzadeh
Husam Salah


Aspergillosis, Aspergillus, MIC, Antifungal, Middle East


Introduction: Aspergillus species are a group of opportunistic molds that can cause various types of aspergillosis in individuals, particularly those with weakened immune systems. In recent years, there have been increasing reports of antifungal resistance among clinical isolates of Aspergillus. Objective: This study aims to determine the in vitro antifungal susceptibility patterns of Aspergillus clinical isolates causing human infections in a subtropical region of the Middle East.

Methods: In this study, the minimum inhibitory/effective concentrations (MICs/MECs) of four antifungal agents (amphotericin B, itraconazole, voriconazole, and caspofungin) were determined using the CLSI M38-A2 broth microdilution method for 60 clinical Aspergillus isolates, including A. flavus (n=39), A. niger (n=9), A. fumigatus (n=6), A. tubingensis (n=5), and A. oryzae (n=1). Statistical analysis was performed using the Chi-square test in SPSS 20 software.

Results: The MEC range for caspofungin was 0.007-4 µg/ml, with a geometric mean (GM) of 0.45 µg/ml. For itraconazole, voriconazole, and amphotericin B, the MIC ranges were 0.031-4 µg/ml, 0.5-4 µg/ml, and 1-4 µg/ml, respectively, with GMs of 1.21 µg/ml, 2.51 µg/ml, and 3.43 µg/ml, respectively.

Conclusion: Among the antifungal agents tested, caspofungin was the most effective against all Aspergillus clinical isolates, while amphotericin B and voriconazole were the least effective. A. flavus, A. niger, and A. tubingensis were more susceptible to caspofungin, whereas A. fumigatus was more susceptible to itraconazole.

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