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Martín-Cerezuela M, Maya Gallegos C, Marqués-Miñana MR, Broch Porcar MJ, Cruz-Sánchez A, Mateo-Pardo JC, Peris Ribera JE, Gimeno R, Castellanos-Ortega Á, Poveda Andrés JL, Ramírez Galleymore P. Isavuconazole Pharmacokinetics in Critically Ill Patients: Relationship with Clinical Effectiveness and Patient Safety. Antibiotics (Basel) 2024; 13:706. [PMID: 39200006 PMCID: PMC11350865 DOI: 10.3390/antibiotics13080706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 09/01/2024] Open
Abstract
Isavuconazole is used to treat fungal infections. This study aims to describe isavuconazole pharmacokinetics in critically ill patients and evaluate their relationship with clinical efficacy and patient safety. We conducted a prospective, observational study in patients treated with intravenous isavuconazole. Samples were collected at predose (Cmin), 1 h (Cmax) and 12 h (C50) after the last dose. The plasma concentration was determined by high-performance liquid chromatography. The relationship between plasma concentration and clinical and microbiological outcomes and safety was evaluated. The influence of covariates (age, sex, weight, SAPS3, creatinine, liver enzymes and extracorporeal devices: continuous renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO)) was analysed. Population pharmacokinetic modelling was performed using NONMEN®. A total of 71 isavuconazole samples from 24 patients were analysed. The mean Cmin was 1.76 (1.02) mg/L; 87.5% reached the optimal therapeutic target and 12.5% were below 1 mg/L. Population pharmacokinetics were best described by a one-compartment model with first-order elimination. No factor had a significant impact on the plasma concentration or pharmacokinetic parameters. Thus, isavuconazole could be safely used in a critically ill population, even in those treated with CRRT and ECMO, from a pharmacokinetic standpoint. Therefore, routine therapeutic drug monitoring may not be strictly necessary in daily clinical practice.
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Affiliation(s)
- María Martín-Cerezuela
- Pharmacy Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (M.M.-C.); (M.R.M.-M.); (A.C.-S.); (J.L.P.A.)
| | - Cristina Maya Gallegos
- Intensive Care Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (C.M.G.); (M.J.B.P.); (J.C.M.-P.); (R.G.); (Á.C.-O.)
| | - María Remedios Marqués-Miñana
- Pharmacy Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (M.M.-C.); (M.R.M.-M.); (A.C.-S.); (J.L.P.A.)
| | - María Jesús Broch Porcar
- Intensive Care Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (C.M.G.); (M.J.B.P.); (J.C.M.-P.); (R.G.); (Á.C.-O.)
| | - Andrés Cruz-Sánchez
- Pharmacy Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (M.M.-C.); (M.R.M.-M.); (A.C.-S.); (J.L.P.A.)
| | - Juan Carlos Mateo-Pardo
- Intensive Care Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (C.M.G.); (M.J.B.P.); (J.C.M.-P.); (R.G.); (Á.C.-O.)
| | | | - Ricardo Gimeno
- Intensive Care Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (C.M.G.); (M.J.B.P.); (J.C.M.-P.); (R.G.); (Á.C.-O.)
| | - Álvaro Castellanos-Ortega
- Intensive Care Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (C.M.G.); (M.J.B.P.); (J.C.M.-P.); (R.G.); (Á.C.-O.)
| | - José Luis Poveda Andrés
- Pharmacy Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (M.M.-C.); (M.R.M.-M.); (A.C.-S.); (J.L.P.A.)
| | - Paula Ramírez Galleymore
- Intensive Care Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (C.M.G.); (M.J.B.P.); (J.C.M.-P.); (R.G.); (Á.C.-O.)
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Alsalman J, Althaqafi A, Alsaeed A, Subhi A, Mady AF, AlHejazi A, Francis B, Alturkistani HH, Ayas M, Bilbisi M, Alsharidah S. Middle Eastern Expert Opinion: Strategies for Successful Antifungal Stewardship Program Implementation in Invasive Fungal Infections. Cureus 2024; 16:e61127. [PMID: 38919246 PMCID: PMC11198984 DOI: 10.7759/cureus.61127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/27/2024] Open
Abstract
In recent years, global public health efforts have increasingly emphasized the critical role of antimicrobial stewardship (AMS) in improving outcomes, reducing costs, and combating the growing threat of antimicrobial resistance. However, antifungal stewardship (AFS) has remained relatively overlooked despite the staggering impact of invasive fungal infections (IFIs). This burden is particularly pronounced in hospitals worldwide, with the Middle East facing significant unmet needs. The rising population of immunocompromised individuals vulnerable to IFI has prompted an increased reliance on antifungal agents for both prevention and treatment. Given the considerable mortality associated with IFIs and the emergence of antifungal resistance, implementing AFS programs in hospital settings is becoming increasingly urgent. In this article, we offer expert insights into the strategies that can be used for successful antifungal stewardship program implementation in IFI. Drawing upon the extensive clinical experience of a multinational and multidisciplinary panel, we present recommendations for optimizing AFS practices. We delve into the challenges and practical considerations of tailoring local AFS initiatives to the evolving landscape of fungal infections. Additionally, we provide actionable recommendations and position statements for the effective implementation of AFS programs, informed by the collective clinical experiences of panel members across their respective countries of practice.
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Affiliation(s)
| | - Abdulhakeem Althaqafi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Infectious Diseases, King Abdullah International Medical Research Center, Jeddah, SAU
- Department of Medicine/Infectious Diseases, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
| | - Ahmad Alsaeed
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Adult Hematology and Stem Cell Transplantation, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Jeddah, SAU
| | - Ahmad Subhi
- Adult Infectious Diseases, Department of Medicine, Al-Qassimi Hospital, Emirates Health Services, Sharjah, ARE
| | - Ahmed F Mady
- Critical Care Medicine, King Saud Medical City, Riyadh, SAU
| | - Ayman AlHejazi
- Department of Oncology, King Abdulaziz Medical City Riyadh, Riyadh, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Bassam Francis
- Hematology, Hematology and Bone Marrow Transplant Center, Baghdad, IRQ
| | | | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Montaser Bilbisi
- Department of Infectious Diseases, Abdali Medical Center, Amman, JOR
| | - Sondus Alsharidah
- Pediatric Stem Cell Transplant Unit, Department of Pediatric Hematology/Oncology, National Bank of Kuwait (NBK) Children's Specialized Hospital, Sabah Central Health Region, KWT
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AlMaghrabi RS, Al-Musawi T, Albaksami O, Subhi AL, Fakih RE, Stone NR. Challenges in the Management of Invasive Fungal Infections in the Middle East: Expert Opinion to Optimize Management Using a Multidisciplinary Approach. Cureus 2023; 15:e44356. [PMID: 37779746 PMCID: PMC10539715 DOI: 10.7759/cureus.44356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 10/03/2023] Open
Abstract
Invasive fungal infection (IFI) is a significant global healthcare concern among critically ill and immunocompromised patients. In Middle Eastern countries, IFI has been steadily increasing among hospitalized patients in the past two decades. Diagnosis of IFI at an early stage is crucial for efficient management. Invasive fungal infection management is complex and requires the involvement of physicians from different specialties. There are several challenges associated with IFI management in the countries in the Middle East. This review aims to understand the key challenges associated with IFI management in the Middle East, encompassing epidemiology, diagnosis, therapeutic options, and optimizing a multidisciplinary approach. In addition, this review aims to incorporate expert opinions from multidisciplinary fields for optimizing IFI management in different Middle Eastern countries by addressing key decision points throughout the patient's journey. Lack of epidemiological data on fungal infections, slow and poorly sensitive conventional culture-based diagnostic tests, limited availability of biomarker testing, lack of awareness of clinical symptoms of the disease, limited knowledge on fungal infections, lack of local practice guidelines, and complicated disease management are the major challenges associated with IFI diagnosis and management in the Middle Eastern countries. Implementation of a multidisciplinary approach, antifungal stewardship, improved knowledge of fungal infections, the use of rapid diagnostic tests, and enhanced epidemiological research are warranted to lower the IFI burden in the Middle East.
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Affiliation(s)
- Reem S AlMaghrabi
- Department of Medicine, Organ Transplant Center, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Tariq Al-Musawi
- Department of Critical Care Medicine, Al Salam Hospital, Al-Khobar, SAU
- Department of Medicine, Royal College of Surgeons in Ireland - Bahrain, Busaiteen, BHR
| | - Osama Albaksami
- Department of Infectious Diseases, Infectious Disease Hospital, Kuwait City, KWT
| | - Ahmad L Subhi
- Department of Infectious Diseases, Al-Qassimi Hospital, Sharjah, ARE
| | - Riad E Fakih
- Department of Hematology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
- Department of Clinical Research, Alfaisal University, Riyadh, SAU
| | - Neil R Stone
- Department of Microbiology, Hospital for Tropical Diseases, London, GBR
- Department of Microbiology, University College London Hospitals, London, GBR
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Ledoux MP, Herbrecht R. Invasive Pulmonary Aspergillosis. J Fungi (Basel) 2023; 9:jof9020131. [PMID: 36836246 PMCID: PMC9962768 DOI: 10.3390/jof9020131] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 01/19/2023] Open
Abstract
Invasive pulmonary aspergillosis is growing in incidence, as patients at risk are growing in diversity. Outside the classical context of neutropenia, new risk factors are emerging or newly identified, such as new anticancer drugs, viral pneumonias and hepatic dysfunctions. Clinical signs remain unspecific in these populations and the diagnostic work-up has considerably expanded. Computed tomography is key to assess the pulmonary lesions of aspergillosis, whose various features must be acknowledged. Positron-emission tomography can bring additional information for diagnosis and follow-up. The mycological argument for diagnosis is rarely fully conclusive, as biopsy from a sterile site is challenging in most clinical contexts. In patients with a risk and suggestive radiological findings, probable invasive aspergillosis is diagnosed through blood and bronchoalveolar lavage fluid samples by detecting galactomannan or DNA, or by direct microscopy and culture for the latter. Diagnosis is considered possible with mold infection in lack of mycological criterion. Nevertheless, the therapeutic decision should not be hindered by these research-oriented categories, that have been completed by better adapted ones in specific settings. Survival has been improved over the past decades with the development of relevant antifungals, including lipid formulations of amphotericin B and new azoles. New antifungals, including first-in-class molecules, are awaited.
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