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Meta-Analysis of Antifungal Resistance Patterns of Aspergillus Species in Iran Publisher Pubmed



I Bahrami Mianrood IBRAHIM ; F Javandoust Gharebagh FARID ; S Khodavaisy SADEGH ; M Ahmadian MARYAM ; I Alavi Darazam ILAD
Authors

Source: Journal of Infection and Public Health Published:2025


Abstract

Background and objectives: Aspergillus infection has several manifestations, ranging from noninvasive aspergillosis to invasive pulmonary and cerebral aspergillosis. Prophylaxis and treatment regimens for aspergillosis rely on triazoles, echinocandins, and polyenes, with specific efficacies, complications, and resistance patterns. Drug selection presents challenges, including differences in resistance rates, drug interactions, and concerns about side effects with long-term use. Aspergillus resistance to antifungal agents is an international concern and has shown an increasing trend. Each region worldwide has a resistance pattern affecting prevention and treatment regimens. Methods: This meta-analysis started with a systematic search through PubMed, Scopus, Web of Science, Scientific Information Database (SID) and MagIran based on a combination of these keywords with “AND/OR” operators: Aspergillus/Aspergilli, resistance/resistant, susceptibility/susceptible, drug, antimicrobial(s), antifungal(s) and Iran. Search results are reported on the basis of the Preferred Reporting Items for Systematic and Meta-analyses (PRISMA). Results: The pooled resistance rates of Aspergillus fumigatus were 6.97 % for amphotericin B, 1.40 % for caspofungin, 17.61 % for itraconazole, 4.56 % for posaconazole, and 14.68 % for voriconazole. The percentage of resistance in Aspergillus flavus was 13.16 % for amphotericin B, 13.09 % for caspofungin, 10.19 % for itraconazole, 1.23 % for posaconazole, and 0.58 % for voriconazole. Conclusion: Our findings highlight the need for antifungal resistance surveillance in Iran. Treatment decisions should consider resistance patterns, host factors, and drug pharmacokinetics. We recommend establishing antifungal stewardship programs to develop evidence-based guidelines. Based on our findings, we suggest posaconazole or voriconazole for A. fumigatus and A. flavus, amphotericin B as alternative therapy, and caspofungin as salvage therapy. © 2025 Elsevier B.V., All rights reserved.
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