Tution G448S is often related withvoriconazole and isavuconazoleresistance [193,34]. Within this study, we isolated environmental ALDH2 site azole-resistant samples of A. fumigatus for the very first time in Spain. These strains were obtained in the atmosphere of a hospital patient’s space, identifying two unique resistance mechanisms (TR34/L98H and G448S) with two diverse genotypes. Out in the 5 samples obtained in the patient’s space 4 were azole-resistant and, out of these 4, three harbored the resistance mechanism G448S and were isogenic.Theremaining strain had the resistance mechanism TR34/L98H and also a various genotype. This confirms that two unique azole-resistant A. fumigatus strains were isolated in the hospital area atmosphere. The two azole resistance profiles identified in this study are in Mite list agreement with research previously performed for strains harboring precisely the same Cyp51A resistance mechanisms [10,13,23]. Previous research in Spain have analyzed A. fumigatus strains from clinical samples and, to date, only a few environmental samples have been studied [44,45]. Although no prior azole-resistant samples happen to be identified within the Spanish environment, environmental samples harboring the same TR34/L98H Cyp51A alteration have been previously collected in other geographic regions getting probably the most popular resistance mechanism found worldwide [15]. This resistance mechanism has been detected in lots of European nations (Germany, Denmark, France, The Netherlands, Italy, Ireland, UK, and Switzerland), Asia (China, India, Iran, Japan, North Korea, Thailand, and Taiwan), Africa (Tanzania), and America (Colombia, USA) [10]. Probably the most outstanding result of this study is the fact that all clinical strains obtained in the patient plus the TP3 environmental sample obtained in the patient’s bathroom have been isogenic, had precisely the same MIC profile and Cyp51A resistance mechanism (TR34/L98H). Thissuggests that the patient had a hospital environmental acquisition in the strain, offered that the houses and hospital atmosphere could be contaminated by A. fumigatus azoleresistant strains [46,47]. Alternatively, the spread from patient to atmosphere isa possibilityand this theory has been not too long ago proposed by other authors [48,49]. A study performed in 2019 [49] was capable to recover A. fumigatus from cough aerosolsof colonized sufferers with cystic fibrosis isogenic to those A. fumigatus obtained in the sputum in the same patient, suggesting environmental contamination by way of aerosols. In addition, the case of a hospital patient acting as a source of A. fumigatus contamination of a hospital area atmosphere after being infected inside the similar hospital, but diverse space has been reported not too long ago [48].Other case reports from the starting of your 2000s have described circumstances in which sufferers diagnosed with IPAhad isogenic strains with these isolated in the ICUs where they have been hospitalized [50,51]. These research bring to light the possibility of conidia getting released through aerosols produced by aspergillosis individuals, contaminating the air and causing patient-to-patient infection. Irrespective of whether the patient of this studybecame colonized at the hospital by an A. fumigatus multi-azole resistant strain present in theJ. Fungi 2021, 7,6 ofenvironment, or when the patient was the supply of an environmental contamination desires to become further investigated as a way to elucidate the relation among these isogenic isolates. Environmental strains harboring the point mutation G448S.