TY  - JOUR
A1  - Heimann, Sebastian M.
A1  - Penack, Olaf
A1  - Heinz, Werner J.
A1  - Rachow, Tobias
A1  - Egerer, Gerlinde
A1  - Kessel, Johanna
A1  - Claßen, Annika Y.
A1  - Vehreschild, Jörg Janne
T1  - Intravenous and tablet formulation of posaconazole in antifungal therapy and prophylaxis: A retrospective, non-interventional, multicenter analysis of hematological patients treated in tertiary-care hospitals
JF  - International Journal of Infectious Diseases
N2  - Objectives
Novel formulations (gastro-resistant tablet and intravenous solution) of posaconazole (POS) have been approved in prophylaxis and therapy of invasive fungal diseases (IFDs). Study aim was to analyze treatment strategies and clinical effectiveness.

Methods
We set up a web-based registry on 
www.ClinicalSurveys.net
 for documentation of comprehensive data of patients who received novel POS formulations. Data analysis was split into two groups of patients who received novel POS formulations for antifungal prophylaxis (posaconazole prophylaxis group) and antifungal therapy (posaconazole therapy group), respectively.

Results
Overall, 180 patients (151 in the posaconazole prophylaxis group and 29 in the posaconazole therapy group) from six German tertiary care centers and hospitalized between 05/2014 – 03/2016 were observed. Median age was 58 years (range: 19 – 77 years) and the most common risk factor for IFD was chemotherapy (n = 136; 76%). In the posaconazole prophylaxis group and posaconazole therapy group, median POS serum levels at steady-state were 1,068 μg/L (IQR 573–1,498 μg/L) and 904 μg/L (IQR 728–1,550 μg/L), respectively (P = 0.776). During antifungal prophylaxis with POS, nine (6%) probable/proven fungal breakthroughs were reported and overall survival rate of hospitalization was 86%. The median overall duration of POS therapy was 18 days (IQR: 7 – 23 days). Fourteen patients (48%) had progressive IFD under POS therapy, of these five patients (36%) died related to or likely related to IFD.

Conclusions
Our study demonstrates clinical effectiveness of antifungal prophylaxis with novel POS formulations. In patients treated for possible/probable/proven IFD, we observed considerable mortality in patients receiving salvage treatment and with infections due to rare fungal species.
KW  - invasive fungal infection
KW  - neutropenia
KW  - posaconazole serum level
KW  - clinical effectiveness
KW  - high-risk patient
Y1  - 2019
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-319567
VL  - 83
ER  - 
TY  - JOUR
A1  - Kessel, Johanna
A1  - Hogardt, Michael
A1  - Aspacher, Lukas
A1  - Wichelhaus, Thomas A.
A1  - Gerkrath, Jasmin
A1  - Rosenow, Emely
A1  - Springer, Jan
A1  - Rickerts, Volker
T1  - Exclusion of Mucorales co-infection in a patient with Aspergillus flavus sinusitis by fluorescence in situ hybridization (FISH)
JF  - Journal of Fungi
N2  - Invasive fungal infections are associated with increased mortality in hematological patients. Despite considerable advances in antifungal therapy, the evaluation of suspected treatment failure is a common clinical challenge requiring extensive diagnostic testing to rule out potential causes, such as mixed infections. We present a 64-year-old patient with secondary AML, diabetes mellitus, febrile neutropenia, and sinusitis. While cultures from nasal tissue grew Aspergillus flavus, a microscopic examination of the tissue was suggestive of concomitant mucormycosis. However, fluorescence in situ hybridization (FISH) using specific probes targeting Aspergillus and Mucorales species ruled out mixed infection. This was confirmed by specific qPCR assays amplifying the DNA of Aspergillus, but not of Mucorales. These results provided a rational basis for step-down targeted therapy, i.e., the patient received posaconazole after seven days of calculated dual therapy with liposomal amphotericin B and posaconazole. Despite clinical response to the antifungal therapy, he died due to the progression of the underlying disease within two weeks after diagnosis of fungal infection. Molecular diagnostics applied to tissue blocks may reveal useful information on the etiology of invasive fungal infections, including challenging situations, such as with mixed infections. A thorough understanding of fungal etiology facilitates targeted therapy that may improve therapeutic success while limiting side effects.
KW  - invasive fungal infection
KW  - fluorescence in situ hybridization (FISH)
KW  - fungal sinusitis
KW  - mixed infection
KW  - Aspergillus
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-267208
SN  - 2309-608X
VL  - 8
IS  - 3
ER  -