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The resistance of  Aspergillus  species to antifungal is increasingly reported and the knowledge of the local epidemiology and antifungal susceptibility pattern is pivotal to define adequate treatment policies. Our study aimed to: 1) describe the  in vitro  antifungal susceptibility profile of the  Aspergillus  species isolated from patients with haematological malignancies in Tunisia; 2) compare the E-test and Sensititre Yeast-One assays for the detection of paradoxical growth and trailing effect, both phenotypes commonly exhibited by  Aspergillus  spp. upon exposure to caspofungin and 3) to evaluate the mortality rate in patients according to the causative  Aspergillus  species and the antifungal treatment.  We tested amphotericin B, itraconazole, voriconazole, posaconazole and caspofungin against 48  Aspergillus  isolates (17,  A. niger ; 18,  A. flavus ; 9,  A. tubingensis ; 1,  A. westerdijkiae ; and 1,  A. ochraceus ) with the E-test. Minimal inhibition concentrations were above the epidemiological cut-off values for amphotericin B in 67% of  A. flavus  strains; for caspofungin in 22% of  A. flavus  strains; and for itraconazole in 22% of  A. tubingensis  strains, voriconazole and posaconazole MICs were below the epidemiological cut-off values for all strains.  When exposed to caspofungin, 42% of the strains exhibited trailing effect and 38% paradoxical growth. Trailing effect occurred in 61% of  A. flavus  strains and paradoxical growth in 62% of  Aspergillus  section  Nigri  strains. E-test and Sensititre Yeast-One assays were only fairly concordant for the detection of these phenotypes. Repeatability of both assays was high for trailing effect but poor for paradoxical growth. The relatively high frequency of amphotericin B resistant strains makes voriconazole best adapted as a first-line treatment of invasive aspergillosis from amphotericin B to voriconazole in this hospital.

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In vitro susceptibility to amphotericin B, itraconazole, voriconazole, posaconazole and caspofungin of Aspergillus spp. isolated from patients with haematological malignancies in Tunisia