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Molecular characterization ofcyp51A from the azole-resistantAspergillus fumigatus isolate 50593 from a lung transplant patient showed Y121F/T289A changes coupled with a 46-bp tandem repeat (TR46) on the promoter, whereascyp51A from the pretherapy isolate,A. fumigatus 47381, showed no changes. This is the first reported case ofA. fumigatus azole resistance due to Y121F/T289A/TR46 in the United States, suggesting that multiple mutational alterations ofcyp51A resulting in high-level azole resistance could occur during prolonged antifungal therapy.

antimicrobial agents and chemotherapy

Molecular Characterization of a Voriconazole-Resistant, Posaconazole-Susceptible Aspergillus fumigatus Isolate in a Lung Transplant Recipient in the United States