Azole-resistant Aspergillus fumigatus in Denmark: a laboratory-based study on resistance mechanisms and genotypes R.H. Jensen, F. Hagen, K.M.T. Astvad,

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Azole-resistant Aspergillus fumigatus in Denmark: a laboratory-based study on resistance mechanisms and genotypes R.H. Jensen, F. Hagen, K.M.T. Astvad,

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Azole-resistant Aspergillus fumigatus in Denmark: a laboratory-based study on resistance mechanisms and genotypes R.H. Jensen, F. Hagen, K.M.T. Astvad, A. Tyron, J.F. Meis, M.C. Arendrup Clinical Microbiology and Infection Volume 22, Issue 6, Pages 570.e1-570.e9 (June 2016) DOI: 10.1016/j.cmi.2016.04.001 Copyright © 2016 Terms and Conditions

Fig. 1 Overview of Aspergillus fumigatus isolates (left) referred to Statens Serum Institut since 2010 and corresponding patients (right). Colours indicate whether isolates (from corresponding patients) were screened for azole resistance (grey, susceptible; red, resistant) or not (white). All isolates were counted, but patients were not counted twice if same resistant isolate was detected, even if different calendar years. Red numbers above each bar indicate percentage of resistance (among susceptibility tested isolates). Chi-square test was used to test for trend in proportions. *p <0.05, **p <0.001. Clinical Microbiology and Infection 2016 22, 570.e1-570.e9DOI: (10.1016/j.cmi.2016.04.001) Copyright © 2016 Terms and Conditions

Fig. 2 Minimum spanning tree of short tandem repeat Aspergillus fumigatus (STRAf) genotyped Danish A. fumigatus isolates including all nine markers. Each circle represents unique genotype. Heavy connecting lines indicate similarity in eight of nine microsatellites. (A) Danish overview illustrating genotypes from azole-susceptible and -resistant isolates as well as clinical and environmental isolates. Furthermore, Roskilde outbreak and seven incidents of shared STRAf genotypes between unrelated isolates have been indicated. RH, University Hospital Copenhagen, Rigshospitalet. (B) Black-and-white representation of Danish genotypes with national flags of where A. fumigatus has been uncovered sharing identical STRAf genotypes on all nine markers. Numbers and percentages in parentheses indicate number of genotypes/total from each country, which are identical to Danish STRAf genotypes. Clinical Microbiology and Infection 2016 22, 570.e1-570.e9DOI: (10.1016/j.cmi.2016.04.001) Copyright © 2016 Terms and Conditions