# Analysis of Susceptibility and Drug Resistance of Antifungal Agents in Aspergillosis and Mucormycosis Patients: A Systematic Review

## TL;DR

This study reviews how fungi causing aspergillosis and mucormycosis respond to antifungal drugs, finding patterns in drug resistance and susceptibility.

## Contribution

The study systematically reviews susceptibility and resistance trends in Aspergillus and Mucorales isolates to guide antifungal therapy.

## Key findings

- A. flavus shows high susceptibility to voriconazole but elevated resistance to amphotericin B and isavuconazole.
- A. fumigatus and A. niger show high susceptibility to amphotericin B but elevated resistance to other azoles.
- Mucorales show the lowest resistance to amphotericin B, with environmental isolates showing higher resistance than clinical isolates.

## Abstract

To evaluate the susceptibility and resistance of Aspergillus and Mucorales isolates to antifungal agents.

Studies in susceptibility or resistance of Aspergillus and Mucorales isolates to antifungal agents published between January 2010 and June 2023 were systematically searched in PubMed, EMBASE and the Cochrane Library. The minimum inhibitory concentration (MIC), susceptibility and resistance data were analysed using CLSI or EUCAST methods.

After following the systematic review processes, 96 studies were included. The total number of isolates was 16,258. Compared with existing MIC distributions and breakpoints or epidemiological cutoff values (ECVs) established by CLSI or EUCAST, for
A. flavus
, the posaconazole and voriconazole MIC values were at or below the ECV, indicating that the isolates were wild‐type (WT) strains; however, the amphotericin B, isavuconazole and itraconazole MIC values were elevated. For
A. fumigatus
, the isavuconazole MIC values were within ECV limits, indicating that the isolates were WT strains; however, the amphotericin B, posaconazole and voriconazole MIC values were elevated. For
A. niger
, the isavuconazole and voriconazole MIC values were within ECV limits, indicating that the isolates were WT strains; however, the amphotericin B and posaconazole MIC values were elevated.
A. flavus
had consistently high in vitro susceptibility to voriconazole, and
A. fumigatus
and
A. niger
had consistently high in vitro susceptibility to amphotericin B. For Mucorales, the resistance to amphotericin B was consistently at the lowest level. The subgroup analysis indicated that the resistance among the strains in the environment was higher than that of the clinical isolates.

Trends in susceptibility and resistance of Aspergillus and Mucorales isolates should be adequately considered in antifungal therapy. The evaluation of drug resistance is beneficial in that it enables clinicians to choose suitable drugs and appropriate doses.