The prevalence of invasive aspergillosis has been increasing during past years. Aspergillus had become one of the most common causes of death in patients with severe immune deficiency. Meanwhile, the sensitivity of aspergillus to azoles decreased significantly worldwide recently. In 2015, we firstly investigated and reported the molecular epidemiology of azole resistance of Aspergillus fumigatus in China. Four azole resistant strains were isolated among 72 clinical strains of A. fumigatus, making the azole resistant rate to 5.56%. Furthermore, we collected 201 strains of A. fumigatus from hospitalized patients in Nanjing during March 2017 to February 2021. We found six strains among them (2.99%) were resistant to both itraconazole and posaconazole. We performed literature reviewing on more than ten relevant reports from China, and found that the azole resistance rate of clinical isolates of A. fumigatus in China was less than 10%. Azole resistance rate of A. fumigatus was higher in east and southeast China, and lower in west and north China. The most prevalent mutation sites related to azole-resistance are located on cyp51A gene, such as TR34/L98H and TR34/L98H/S297T/F495I. The azole resistant A. fumigatus strains isolated clinically in China are sensitive to amphotericin B and its liposomes, echinocandins, etc. In addition, non-cyp51A gene mutations related to azole-resistance of clinical strains of A. fumigatus in China was increasing. Meanwhile, the proportion of A. flavus, A. terreus and A. niger in clinical Aspergillus strains is gradually increasing. Therefore, drug resistance of them needs more investigation. Azole resistance of A. fumigatus in China is related to agricultural triazole induction.

Musang Liu is a MD and PhD from Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College. Her major is Medical Mycology and published a series of original articles about azole resistance of Aspergillus fumigatus.