Do high MICs predict the outcome in invasive fusariosis?

Abstract

Background

Invasive fusariosis (IF) affects mostly severely immunocompromised hosts and is associated with poor outcome. Since Fusarium species exhibit high MICs for most antifungal agents, this could explain the poor prognosis. However, a clear-cut correlation between MIC and outcome has not been established.

Objective

To evaluate the correlation between MIC and outcome (6 week death rate) in patients with IF.

Methods

We performed a multicentre retrospective study of patients with IF who received treatment and had MIC levels determined by EUCAST or CLSI for the drug(s) used during treatment. We compared the MIC50 and MIC distribution among survivors and patients who died within 6 weeks from the diagnosis of IF.

Results

Among 88 patients with IF, 74 had haematological diseases. Primary treatment was monotherapy in 52 patients (voriconazole in 27) and combination therapy in 36 patients (liposomal amphotericin B + voriconazole in 23). The MIC50 and range for the five most frequent agents tested were: voriconazole 8 mg/L (range 0.5-64), amphotericin B 2 mg/L (range 0.25-64), posaconazole 16 mg/L (range 0.5-64), itraconazole 32 mg/L (range 4-64), and isavuconazole 32 mg/L (range 8-64). There was no difference in MIC50 and MIC distribution among survivors and patients who died. By contrast, persistent neutropenia and receipt of corticosteroids were strong predictors of 6 week mortality.

Conclusions

Our study did not show any correlation between MIC and mortality at 6 weeks in patients with IF.

Type

Journal article

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1093/jac/dkaa516

Publication Info

Nucci, Marcio, Jeffrey Jenks, George R Thompson, Martin Hoenigl, Marielle Camargo Dos Santos, Fabio Forghieri, Juan Carlos Rico, Valentina Bonuomo, et al. (2021). Do high MICs predict the outcome in invasive fusariosis?. The Journal of antimicrobial chemotherapy, 76(4). pp. 1063–1069. 10.1093/jac/dkaa516 Retrieved from https://hdl.handle.net/10161/28608.

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Scholars@Duke

Jenks

Jeffrey Daniel Jenks

Adjunct Associate Professor in the Department of Medicine

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