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Breakthrough fungal infections in stem cell transplant recipients receiving voriconazole

Alexander Imhof1, S Arunmozhi Balajee, David N Fredricks

  • 1Program in Infectious Diseases, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|September 10, 2004
PubMed

Insights

Voriconazole resistance in fungi is a growing concern. This study found breakthrough fungal infections in 13 patients receiving voriconazole, including resistant Zygomycetes and Candida glabrata.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Pharmacology

Background:

  • Voriconazole is a key antifungal agent.
  • Emerging resistance to voriconazole in fungal pathogens is a clinical concern.
  • Decreased susceptibility has been observed in various fungi.

Purpose of the Study:

  • To report on breakthrough fungal infections in patients treated with voriconazole.
  • To identify the types of fungi causing these infections.
  • To assess the susceptibility of these isolates to voriconazole.

Main Methods:

  • Retrospective analysis of patient data from September 1998 to September 2003.
  • Identification of fungal isolates from breakthrough infections.
  • Determination of minimal inhibitory concentrations (MICs) for voriconazole.

Main Results:

  • Thirteen of 139 patients (9.4%) experienced breakthrough fungal infections.
  • Zygomycetes were identified in 6 cases, and Candida glabrata in 4 cases.
  • All available isolates showed voriconazole MICs of >= 1 microg/mL, indicating resistance.

Conclusions:

  • Voriconazole-resistant fungi, including Zygomycetes and Candida glabrata, can cause invasive infections.
  • These infections can occur in patients previously treated successfully for aspergillosis.
  • Monitoring for and managing voriconazole resistance is crucial.

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