International retrospective analysis of 73 cases of invasive fusariosis treated with voriconazole.

Abstract

The outcomes for 73 invasive fusariosis patients treated with voriconazole were investigated. Patients with proven (n = 67) or probable (n = 6) infections were identified from the voriconazole clinical database (n = 39) and the French National Reference Center for Mycoses and Antifungals database (n = 34). Investigator-determined success was a complete or partial response. Survival was determined from day 1 of voriconazole therapy to the last day known alive. Patients were 2 to 79 years old (median, 43 years), and 66% were male. Identified Fusarium species (62%) were F. solani, F. moniliforme, F. proliferatum, and F. oxysporum. Underlying conditions analyzed included hematopoietic stem cell transplant (HSCT; 18%), hematologic malignancy (HM; 60%), chronic immunosuppression (CI; 12%), or other condition (OC; 10%). Infection sites were brain (5%), disseminated excluding brain (67%), lungs/sinus (15%), and other (12%). Most patients (64%) were or had recently been neutropenic (<500 cells/mm(3)). Therapy duration was 1 to 480 days (median, 57 days), with a 47% success rate. Baseline neutropenia impacted success adversely (P ≤ 0.03). Success varied by underlying condition (HSCT, 38%; HM, 45%; CI, 44%; OC, 71%) and infection site (brain, 0%; disseminated, 45%; other, 56%; lung/sinus, 64%) (P > 0.05). Combination therapy (13 patients) was no better than treatment with voriconazole alone. Overall, 59% of the patients died (49% died of fusariosis), and 90-day survival was 42%. Site of infection influenced survival (P = 0.02). Median survival (in days) by species was as follows: F. solani, 213; F. oxysporum, 112; Fusarium spp., 101; F. proliferatum, 84; F. moniliforme, 76. We conclude that voriconazole is a therapeutic option for invasive fusariosis.

• Authors: Olivier Lortholary, Gaelle Obenga, Pinaki Biswas, Denis Caillot, Elisabeth Chachaty, Anne-Lise Bienvenu, Muriel Cornet, John Greene, Raoul Herbrecht, Claire Lacroix, Frédéric Grenouillet, Issam Raad, Karine Sitbon, Peter Troke, French Mycoses Study Group
• Journal: Antimicrobial agents and chemotherapy (Antimicrob Agents Chemother) Vol. 54 Issue 10 Pg. 4446-50 (Oct 2010) ISSN: 1098-6596 [Electronic] United States
• PMID: 20625156 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antifungal Agents
• Pyrimidines
• Triazoles
• Voriconazole

Topics

• Adolescent
• Adult
• Aged
• Antifungal Agents (therapeutic use)
• Child
• Child, Preschool
• Female
• Fusarium (drug effects, pathogenicity)
• Humans
• Male
• Middle Aged
• Mycoses (drug therapy, mortality)
• Pyrimidines (therapeutic use)
• Retrospective Studies
• Treatment Outcome
• Triazoles (therapeutic use)
• Voriconazole
• Young Adult