(New) Methods for Detection of Resistance in Clinical Samples.

Purpose Of Review: The incidence of invasive aspergillosis has increased substantially over the past few decades, accompanied by a change in susceptibility patterns of with increasing resistance observed against triazole antifungals, including voriconazole and isavuconazole, the most commonly used antifungal agents for the disease. Culture-based methods for determining triazole resistance are still the gold standard but are time consuming and lack sensitivity. We sought to provide an update on non-culture-based methods for detecting resistance patterns to .

Recent Findings: New molecular-based approaches for detecting triazole resistance to , real-time polymerase chain reaction (PCR) to detect mutations to the protein, have been developed which are able to detect most triazole-resistant strains in patients with invasive aspergillosis.

Summary: Over the last few years, a number of non-culture-based methods for molecular detection of triazole resistance have been developed that may overcome some of the limitations of culture. These molecular methods are therefore of high epidemiological and clinical relevance, mainly in immunocompromised patients with hematological malignancies, where culture has particularly limited sensitivity. These assays are now able to detect most triazole-resistant strains. Given that resistance rates vary, clinical utility for these assays still depends on regional resistance patterns.