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Mortality rates due to Cryptococcus neoformans var. grubii fungemia remain significant despite treatment with antifungal drugs. The predictive function of antifungal susceptibility and its correlation with treatment outcome remains controversial. A retrospective study was conducted from January 1, 2009, to December 31, 2016, on 85 patients with C. neoformans var. grubii fungemia confirmed by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry. Antifungal drug susceptibility was determined using the YeastONE™ colorimetric broth microdilution method coupled with Vizion™ System following the Clinical and Laboratory Standards Institute guidelines. Six antifungal agents-amphotericin B, fluconazole, flucytosine, itraconazole, posaconazole, and voriconazole-were tested. The patients' demographic data and clinical information were abstracted for further analyses. Antifungal regimens consisting of amphotericin B with or without fluconazole or flucytosine were administered for induction treatment of these patients, followed with intravenous or oral fluconazole for maintenance therapy. Clinical outcomes were defined by 14- and 30-day mortality rates. Risk factors associated with outcomes were fitted in a logistic regression model by univariate or multivariate method. Eighty-five patients with C. neoformans var. grubii fungemia were enrolled in the study. The Sequential Organ Failure Assessment Score, Glasgow Coma Scale, Charlson comorbidity score, and adequate duration of therapy for amphotericin B were predictors for mortality in univariate analysis. Antifungal susceptibility testing with YeastONE™ does not predict clinical outcomes of C. neoformans var. grubii fungemia. Greater disease severity, high comorbidities, poor consciousness level, and inappropriate treatment were associated with increased mortality in cryptococcemia cases., (© The Author(s) 2021. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.)

Objective: This study intends to analyze the data of fungemia in a large tertiary hospital from 2010 to 2019, and is aimed at understanding its epidemic characteristics and drug resistance., Methods: The "Hospital Infection Real-Time Monitoring System" was used to retrieve the case information of patients who were hospitalized for more than 48 hours from 2010 to 2019. The questionnaire was designed to collect patients' basic information, infection situation, drug resistance, and other related information. Statistical software was used for analysis., Results: The fungi detection rate was in the range of 0.19%~0.75% in ten years, the average rate was 0.29%, and the rate 0.2%~0.3% since 2013, which was lower than that from 2010 to 2012. Non- Candida albicans was the main fungus, accounting for 62.50%. The drug resistance of non- C. albicans was higher than that of C. albicans , among which C. glabrata had the highest resistance rate. Data analysis showed that the patients with more serious basic diseases, combined with infection of other sites, surgery, long hospital stay, combination of antibiotics, and invasive catheterization, were more likely to occur fungemia., Conclusion: We should pay more attention to the patients with high-risk factors of fungemia and focus on the drug resistance of non- C. albicans , choose the right antifungal drugs, so as to improve the level of diagnosis and treatment., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2021 Yanling Bai et al.)

To understand the characterizations of azole resistance in Aspergillus fumigatus from potting soil samples in the hospital, a total of 58 samples were collected. Among 106 A. fumigatus samples obtained, 5 isolates from 4 soil samples located in the gerontology department were identified as azole-resistant A. fumigatus (ARAF). Four ARAF isolates harbored the TR 34 /L98H allele, and the other one had no mutation in the cyp51A gene. Among 174 A. fumigatus samples selected for genotyping, TRESPERG typing obtained a close discriminatory power (Simpson's index of diversity [DI], 0.9941; 95% confidence interval [CI], 0.9913 to 0.9968) compared with the short tandem repeat (STR) typing (DI, 0.9997; 95% CI, 0.9976 to 1.0000). Genotyping showed that the TR 34 /L98H isolates in the hospital had a close genetic relationship with ARAF isolates from China and many other countries. In conclusion, this study indicated the presence of ARAF in potting soil samples from the hospital, which might pose a risk of causing ARAF infection in patients., (Copyright © 2020 American Society for Microbiology.)

Fusarium graminearum species complex (FGSC), causing Fusarium head blight (FHB) of wheat, has species-specific geographical distributions in wheat-growing regions. In recent years, benzimidazole resistance of FHB pathogens has been largely widespread in China. Although the demethylation inhibitor fungicide metconazole has been used for FHB control in some countries, no information about metconazole sensitivity of Chinese FHB pathogen populations and efficacy of metconazole in FHB control in China is available. In this study, the sensitivity of FGSC to metconazole was measured with 32 carbendazim-sensitive strains and 35 carbendazim-resistant strains based on mycelial growth. The 50% effective concentration values of 67 strains were normally distributed and ranged from 0.0209 to 0.0838 μg ml -1 , with a mean of 0.0481 ± 0.0134 μg ml -1 . No significant difference in metconazole sensitivity was observed between carbendazim-sensitive and -resistant populations. An interactive effect of metconazole and phenamacril, a novel cyanoacrilate fungicide approved in China against Fusarium spp., in inhibiting mycelial growth showed an additive interaction at different ratios. Furthermore, field trials to evaluate the effect of metconazole and metconazole + phenamacril treatments in FHB control, deoxynivalenol (DON) production, and grain yields were performed. Compared with the fungicides carbendazim and phenamacril currently used in China, metconazole exhibits a better efficacy for FHB control, DON production, and grain yields, and dramatically reduces use dosages of chemical compounds in the field. The mixture of metconazole and phenamacril at ratios of 2:3 and 1:2 showed the greatest efficacy for FHB control, DON production, and grain yields among all the fungicide treatments but its use dosages were higher in comparison with metconazole alone. In addition, FHB control, grain yields, and DON levels were significantly correlated with each other, showing that visual disease indices can be used as an indicator of grain yields and DON contamination. Meanwhile, the frequency of carbendazim-resistant alleles in F. graminearum populations was dramatically reduced after metconazole and phenamacril alone and the mixture of metconazole and phenamacril applications, indicating that metconazole and a mixture of metconazole and phenamacril can be used for carbendazim resistance management of FHB in wheat. Overall, the findings of this study provide important data for resistance management of FHB and reducing DON contamination in wheat grains.

Altogether, 192 Botrytis cinerea isolates collected from tomato greenhouses at different locations in Hubei Province were evaluated for their sensitivity to fungicides procymidone and zoxamide. The mean effective concentration to cause 50% growth inhibition (EC 50 ) values of procymidone for sensitive and resistant isolates were 0.25 and 3.60 μg/ml, respectively. The frequency of procymidone-resistant (Pro R ) isolates was 18%, and the highest frequency was recorded in Jingmen. Positive cross-resistance was observed for Pro R isolates to other dicarboximide fungicides but not to phenylpyrroles. Significant differences were observed for fitness parameters (i.e., mycelial growth, osmotic sensitivity, and virulence between sensitive and resistant isolates). Amino acid sequence of the Bos1 gene revealed that Pro R isolates carried either point mutations at codon 365 (I365S) or a pair of point mutations at codons 369 (Q369P) and 373 (N373S). For zoxamide, the mean EC 50 values for sensitive and resistant isolates were 0.22 and 5.32 μg/ml, respectively. Approximately 14% of the isolates were found to be resistant to zoxamide, and the highest frequency of resistance was also observed in Jingmen. There was positive cross-resistance for zoxamide-resistant (Zox R ) isolates to carbendazim. No significant differences were observed for fitness parameters between zoxamide-sensitive and Zox R isolates. Sequence analysis of the β-tubulin gene of Botrytis cinerea revealed two previously reported point mutations (E198A and E198K) and one new point mutation (T351I). This new mutation was detected in only those isolates which possessed the E198K but not E198A substitution. This study allows for a better understanding of the resistance development profile in Hubei Province. Results will be useful for the improvement of fungicide resistance management strategies.

Azole resistance in Aspergillus fumigatus has emerged as a worldwide public health problem. We sought here to demonstrate the occurrence and characteristics of azole resistance in A. fumigatus from different parts of China. A total of 317 clinical and 144 environmental A. fumigatus isolates from 12 provinces were collected and subjected to screening for azole resistance. Antifungal susceptibility, cyp51A gene sequencing, and genotyping were carried out for all suspected azole-resistant isolates and a subset of azole-susceptible isolates. As a result, 8 (2.5%) clinical and 2 (1.4%) environmental A. fumigatus isolates were identified as azole resistant. Five azole-resistant strains exhibit the TR34/L98H mutation, whereas four carry the TR34/L98H/S297T/F495I mutation in the cyp51A gene. Genetic typing and phylogenetic analysis showed that there was a worldwide clonal expansion of the TR34/L98H isolates, while the TR34/L98H/S297T/F495I isolates from China harbored a distinct genetic background with resistant isolates from other countries. High polymorphisms existed in the cyp51A gene that produced amino acid changes among azole-susceptible A. fumigatus isolates, with N248K being the most common mutation. These data suggest that the wide distribution of azole-resistant A. fumigatus might be attributed to the environmental resistance mechanisms in China., (Copyright © 2016, American Society for Microbiology. All Rights Reserved.)

Seventy-two A. fumigatus clinical isolates from China were investigated for azole resistance based on mutations of cyp51A. We identified four azole-resistant strains, among which we found three strains highly resistant to itraconazole, two of which exhibit the TR34/L98H/S297T/F495I mutation, while one carries only the TR34/L98H mutation. To our knowledge, the latter has not been found previously in China. The fourth multiazole-resistant isolate (with only moderate itraconazole resistance) carries a new G432A mutation., (Copyright © 2015, American Society for Microbiology. All Rights Reserved.)