Vergidis P, Sendi P, Alkhateeb HB, Nguyen MH. How do I manage refractory invasive pulmonary aspergillosis.
Clin Microbiol Infect 2024;
30:755-761. [PMID:
38286175 DOI:
10.1016/j.cmi.2024.01.015]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/06/2023] [Accepted: 01/20/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND
Invasive aspergillosis is associated with significant morbidity and mortality in patients with haematologic malignancies and haematopoietic cell transplant recipients. The prognosis is worse among patients who have failed primary antifungal treatment.
OBJECTIVES
We aim to provide guidance on the diagnosis and management of refractory invasive pulmonary aspergillosis.
SOURCES
Using PubMed, we performed a review of original articles, meta-analyses, and systematic reviews.
CONTENT
We discuss the diagnostic criteria for invasive pulmonary aspergillosis and the evidence on the treatment of primary infection. We outline our diagnostic approach to refractory disease. We propose a treatment algorithm for refractory disease and discuss the role of experimental antifungal agents.
IMPLICATIONS
For patients with worsening disease while on antifungal therapy, a thorough diagnostic evaluation is required to confirm the diagnosis of aspergillosis and exclude another concomitant infection. Treatment should be individualized. Current options include switching to another triazole, transitioning to a lipid formulation of amphotericin B, or using combination antifungal therapy.
Collapse