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Frontiers in veterinary science2025; 12; 1507997; doi: 10.3389/fvets.2025.1507997

Azole resistance in Aspergillus isolates from animals or their direct environment (2013-2023): a systematic review.

Abstract: The resistance of species to azoles in human medicine is gaining increasing attention, and the role of animals and agricultural practices in this issue is becoming a significant source of concern. To gain better insights into the occurrence of azole resistance in spp. isolates from animals, a systematic literature review was conducted. Searches were conducted in the PubMed and Scopus databases for articles addressing azole resistance in spp. isolates from both animals and their immediate environments, published between 2013 and 2024. Descriptive clinical cases were analyzed separately from articles providing susceptibility test results. MIC and MIC values, along with the number of non-wild type (NWT) isolates, were either directly extracted from the articles or calculated based on published results of individual isolates or MIC distributions. Ultimately, seventy-three out of 2042 articles were included in the analysis. Articles reporting clinical cases included only horses, dogs, cats, zoo animals, and wildlife, with the majority of cases occurring outside Europe. Generally, successful clinical remission or recovery followed prolonged and continuous fungicide azole treatments, regardless of the azole- spp.-animal category combination. Itraconazole was the most frequently noted treatment in clinical cases involving companion animals (dogs and cats) and horses. The weighted geometric mean of the MIC values for itraconazole was lowest for isolates within the companion animal category. Zoo animals and wildlife were often treated with voriconazole, and the weighted geometric mean of the MIC values for this and other azoles was equal to or slightly lower than those calculated for isolates from other animal categories. NWT isolates were reported in zoo animals and wildlife, horses, companion animals, and poultry for several azoles, occurring both in Europe and beyond, in healthy and sick animals. In conclusion, zoo animals and wildlife, horses, and poultry represent a more significant concern regarding the prevalence of and NWT isolates than other animal categories. Insufficient data prevented conclusions about the situation specifically in Europe, and therefore, more systematic and comparable data are required.
Copyright © 2025 Dieste-Pérez, Holstege, de Jong and Heuvelink.
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Publication Date: 2025-03-20 PubMed ID: 40182641PubMed Central: PMC11967370DOI: 10.3389/fvets.2025.1507997Google Scholar: Lookup
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  • Journal Article
  • Systematic Review

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Objective Overview

  • This study systematically reviewed published research on the resistance of Aspergillus species to azole antifungal drugs in animals and their immediate environments from 2013 to 2024.
  • It aimed to understand the occurrence and implications of azole resistance across various animal categories, focusing on clinical cases and susceptibility testing data.

Background and Importance

  • Azoles are a critical class of antifungal drugs used to treat Aspergillus infections, particularly in human medicine.
  • Increasing azole resistance in Aspergillus species raises concerns for treatment efficacy and public health.
  • Animals and agricultural environments may serve as reservoirs or sources for resistant Aspergillus strains, potentially impacting human and animal health.
  • Understanding azole resistance patterns in animal isolates can guide treatment strategies and antimicrobial stewardship.

Methodology

  • A systematic literature search was performed using PubMed and Scopus databases.
  • The search targeted studies published between 2013 and 2024 focusing on azole resistance in Aspergillus isolates collected from animals or their immediate environments.
  • From 2042 identified articles, 73 met inclusion criteria for detailed review.
  • Data extracted included:
    • Clinical case reports involving animal infections with Aspergillus.
    • In vitro antifungal susceptibility test results, specifically minimum inhibitory concentration (MIC) values and non-wild type (NWT) isolate numbers.
  • Data handling involved direct extraction or calculation of MIC and MIC90 values based on reported distributions.

Key Findings

  • Animal Categories Studied: Clinical cases were primarily reported in horses, dogs, cats, zoo animals, and wildlife.
  • Geographic Distribution: Most clinical cases occurred outside Europe, making regional comparisons limited.
  • Treatment Outcomes:
    • Successful remission or recovery was generally achieved with prolonged, continuous azole fungicide therapy.
    • Itraconazole was the most common azole used, especially in dogs, cats, and horses.
  • Susceptibility Data:
    • The weighted geometric mean MICs for itraconazole were lowest in Aspergillus isolates from companion animals, indicating relatively higher susceptibility.
    • Zoo animals and wildlife were often treated with voriconazole, and MIC values for voriconazole and other azoles were similar or slightly lower in these groups compared to others.
  • Resistance Prevalence:
    • NWT isolates, indicating potential resistance, were identified among zoo animals, wildlife, horses, companion animals, and poultry.
    • NWT isolates were detected in both healthy and sick animals and in multiple geographic regions, including Europe.
    • Zoo animals, wildlife, horses, and poultry showed a higher prevalence of NWT isolates compared to other animal categories.

Conclusions and Recommendations

  • Zoo animals, wildlife, horses, and poultry represent important reservoirs for azole-resistant Aspergillus, having implications for animal health and potentially for human exposure.
  • Current data for Europe are insufficient to draw firm conclusions about regional azole resistance patterns in animals.
  • There is a need for more systematic, standardized, and comparable surveillance of azole resistance in animal Aspergillus isolates globally.
  • Improved monitoring could inform clinical treatment decisions and help manage the risk of spread of resistant strains between animals and humans.

Cite This Article

APA
Dieste-Pérez L, Holstege MMC, de Jong JE, Heuvelink AE. (2025). Azole resistance in Aspergillus isolates from animals or their direct environment (2013-2023): a systematic review. Front Vet Sci, 12, 1507997. https://doi.org/10.3389/fvets.2025.1507997

Publication

Frontiers in veterinary science
ISSN: 2297-1769
NlmUniqueID: 101666658
Country: Switzerland
Language: English
Volume: 12
Pages: 1507997
PII: 1507997

Researcher Affiliations

Dieste-Pérez, Lucía
  • Royal GD, Deventer, Netherlands.
Holstege, Manon M C
  • Royal GD, Deventer, Netherlands.
de Jong, Judith E
  • Royal GD, Deventer, Netherlands.
Heuvelink, Annet E
  • Royal GD, Deventer, Netherlands.

Conflict of Interest Statement

LD-P, MH, JJ and AH were employed by Royal GD. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Citations

This article has been cited 1 times.
  1. Shiroma Buri MC, Castro-Ríos K, Ramalho da Cruz AD, Claudio TM, Ceresini PC. A One Health Perspective on Aspergillus fumigatus in Brazilian Dry Foods: High Genetic Diversity and Azole Susceptibility.. J Fungi (Basel) 2026 Jan 16;12(1).
    doi: 10.3390/jof12010072pubmed: 41590484google scholar: lookup
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