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An Update on Breakthrough Invasive Mold Infections
Vera Portillo1,2, Dionysios Neofytos3
1Division of Infectious Diseases, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland. veraportillo@gmail.com.
Abstract:
The incidence of breakthrough mold infections (bIMI) has been increasing, due to routine administration of broad-spectrum antifungal prophylaxis and an increasing pool of high-risk patient populations, with fungi more challenging to treat, resulting in a sustained high mortality, despite progress in diagnostic and therapeutic options. Pharmacokinetics of antifungal drugs, fungal, and host, including genetic, factors play a role in the emergence of bIMI. Suggested therapeutic approaches have included change of antifungal class treatment, with amphotericin-B products predominating as first-line empirical treatment and switching from one broad-spectrum azole to another remaining the most frequently used treatment modalities. Future perspectives include determining individual susceptibility to IMI to tailor prophylaxis and treatment strategies, improved diagnostic tests, and the introduction of new antifungal agents that may reduce morbidity and mortality caused by bIMI.
Insights
Breakthrough mold infections (bIMI) are rising due to antifungal prophylaxis and high-risk patients. Current treatments include amphotericin-B and azole switches, with future strategies focusing on personalized susceptibility and new agents.
Area of Science:
- Mycology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Increasing incidence of breakthrough mold infections (bIMI) in immunocompromised patients.
- Challenges in treating these infections due to resistant fungal strains and complex host factors.
- Limitations of current diagnostic and therapeutic options leading to high mortality rates.
Purpose of the Study:
- To review the current landscape of breakthrough mold infections (bIMI).
- To discuss the pharmacokinetic, fungal, and host factors influencing bIMI emergence.
- To explore current and future therapeutic strategies for managing bIMI.
Main Methods:
- Literature review of recent studies on bIMI.
- Analysis of pharmacokinetic data for antifungal agents.
- Examination of host and fungal genetic factors implicated in bIMI.
Main Results:
- Breakthrough mold infections (bIMI) are increasingly prevalent, driven by antifungal prophylaxis and vulnerable patient populations.
- Amphotericin-B and azole-based therapies are primary treatment modalities, with frequent class switching observed.
- Pharmacokinetic properties, host genetics, and fungal characteristics significantly influence bIMI development.
Conclusions:
- Despite advances, bIMI continue to pose a significant mortality risk.
- Personalized prophylaxis and treatment strategies, informed by individual susceptibility, are crucial for future management.
- Development of novel antifungal agents and improved diagnostics are essential to reduce bIMI morbidity and mortality.
