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Aspergillus fumigatus  triazole resistance is an emerging concern for treating chronically infected/colonized patients. This study sought to evaluate the performance of PCR assays to detect  Aspergillus  fungi together with azole resistance in sputum samples from cystic fibrosis (CF) patients. In total, 119 sputum samples from 87 CF patients were prospectively processed for  Aspergillus  detection by means of mycological culture and four qPCR assays, 2 in-house methods and two commercial multiplex real-time PCR assays simultaneously detecting  Aspergillus  and the most relevant  cyp51A  gene mutations (MycoGENIE ®  and AsperGenius ® ). Azole susceptibility of  A. fumigatus  isolates was assessed using Etest ®  method and  cyp51A  gene mutation were characterized by sequencing. The overall rate of  Aspergillus  detection with the four qPCR assays ranged from 47.9 to 57.1%, contrasting with 42/119 (35.3%) positive cultures with  A. fumigatus . The high sensitivity of PCR on sputum could then contribute to more effective grading of  Aspergillus  disease in CF patients. Five out of 41 isolated strains (12.2%) exhibited azole-resistant MIC patterns, three of which harbored  cyp51A  mutations and only 1/3 with the sequence TR 34 /L98H. Combined with culture, PCR assay achieved high sensitivity  Aspergillus  screening in CF samples. However,  cyp51A  targeting was only moderately effective for azole resistance monitoring, while  Aspergillus  resistance remains of great concern.

Performance of Molecular Approaches for Aspergillus Detection and Azole Resistance Surveillance in Cystic Fibrosis