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High azole MICs in Fusarium spp.: a key factor in treatment decisions for cancer patients?
Raquel Keiko de Luca Ito1, Marcia de Souza Carvalho Melhem2,3, Lucas Xavier Bonfietti4
1Instituto do Câncer do Estado de São Paulo, São Paulo, São Paulo, Brazil.
Abstract:
Invasive fusariosis (IF) is an exceptionally severe disease, particularly affecting patients with prolonged neutropenia. Even with antifungal therapy, mortality rates remain high, emphasizing the need for stringent control over hospital environment and further research to enhance patient outcomes. This study aims to assess the antifungal susceptibility of clinical and environmental Fusarium isolates and their clinical relevance in a cancer hospital. Sixteen environmental and 21 clinical isolates were identified, with the Fusarium solani species complex being the most common. Amphotericin B demonstrated in vitro activity, but most isolates exhibited elevated minimum inhibitory concentrations (MICs) for azoles. A total of 80% of patients had IF, primarily those with hematological malignancies, and the 30-day mortality rate was 43.8%. Isolates with elevated MICs were often managed with combination therapy. In conclusion, elevated azole MICs may lead to increased use of combination therapy in real-world clinical settings. Our findings emphasize the importance of careful interpretation of antifungal susceptibility testing results in IF management.
Insights
Invasive fusariosis (IF) is a severe fungal infection, especially in neutropenic patients. High azole minimum inhibitory concentrations (MICs) in Fusarium isolates may necessitate combination antifungal therapy, impacting patient outcomes.
Area of Science:
- Mycology
- Infectious Diseases
- Clinical Microbiology
Background:
- Invasive fusariosis (IF) presents a severe clinical challenge, particularly for immunocompromised patients with prolonged neutropenia.
- High mortality rates associated with IF underscore the critical need for environmental control and improved therapeutic strategies.
Purpose of the Study:
- To evaluate the antifungal susceptibility profiles of clinical and environmental Fusarium isolates.
- To determine the clinical relevance and outcomes of IF in a cancer hospital setting.
Main Methods:
- Identification and antifungal susceptibility testing (MIC determination) of 16 environmental and 21 clinical Fusarium isolates.
- Retrospective analysis of IF patient cases, including underlying conditions, treatment, and mortality.
Main Results:
- Fusarium solani species complex was the predominant isolate.
- Amphotericin B showed in vitro activity, while most isolates displayed elevated MICs for azoles.
- 80% of IF patients had hematological malignancies, with a 43.8% 30-day mortality rate.
Conclusions:
- Elevated azole MICs in Fusarium isolates correlate with increased use of combination antifungal therapy in clinical practice.
- Accurate interpretation of antifungal susceptibility testing is crucial for effective IF management and improving patient survival.
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