Multidrug Resistance inAspergillus fumigatus

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Abstract
Antifungal azoles with activity against aspergillus include itraconazole and three new drugs: voriconazole, posaconazole, and ravuconazole. Voriconazole was recently approved for the treatment of invasive mold infections, and posaconazole and ravuconazole are undergoing clinical evaluation. Resistance of Aspergillus fumigatus against itraconazole has been documented, and a degree of cross-resistance between itraconazole and posaconazole and between voriconazole and ravuconazole has been suggested on the basis of similarities in molecule structure.1 We describe a patient in whom invasive aspergillosis developed as a result of infection with an A. fumigatus strain for which the minimal inhibitory concentrations (MICs) of all antifungal azoles were high.