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Changing Epidemiology of Invasive Mold Infections in Patients Receiving Azole Prophylaxis

Frederic Lamoth1,2,3,4, Shimin J Chung1,5, Lauro Damonti3

  • 1Division of Infectious Diseases and International Health, Department of Medicine, and.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|February 16, 2017
PubMed

Insights

Breakthrough invasive mold infections during antifungal prophylaxis are rare but show a concerning rise in non-Aspergillus and multidrug-resistant molds, necessitating further study.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Clinical Pharmacy

Background:

  • Invasive mold infections (IMIs) are serious complications in immunocompromised patients.
  • Antifungal prophylaxis with posaconazole or voriconazole is standard, but breakthrough infections occur.
  • Epidemiological data on breakthrough IMIs during prophylaxis are limited.

Purpose of the Study:

  • To analyze the characteristics of breakthrough IMIs during posaconazole or voriconazole prophylaxis.
  • To compare breakthrough IMIs with non-breakthrough IMIs in terms of causative agents.
  • To identify trends in mold species and antifungal resistance.

Main Methods:

  • Retrospective analysis of microbiologically documented IMIs.
  • Comparison between breakthrough (n=24) and non-breakthrough (n=66) IMI cases.
  • Identification of mold species and assessment of antifungal susceptibility.

Main Results:

  • Breakthrough IMIs showed a shift towards non-Aspergillus molds.
  • A significantly higher proportion of rare, multidrug-resistant molds were identified in breakthrough cases.
  • Specific non-Aspergillus species and resistance patterns were noted.

Conclusions:

  • Breakthrough IMIs during azole prophylaxis are associated with less common and more resistant mold pathogens.
  • Current prophylaxis may be less effective against emerging resistant molds.
  • Further research is needed to guide optimal antifungal strategies for these rare but severe infections.
Keywords:
Aspergillus ustusScopulariopsis.antifungal prophylaxisinvasive aspergillosismucormycosis

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