title: Failure of posaconazole therapy in a renal transplant patient with invasive aspergillosis due to Aspergillus fumigatus with attenuated susceptibility to posaconazole.
abstract: We report the case of a kidney transplant recipient with invasive aspergillosis due to Aspergillus fumigatus resistant to voriconazole and intermediately susceptible to posaconazole who failed posaconazole therapy. Plasma posaconazole concentrations indicated an unfavorable ratio of the area under the concentration-time curve over the MIC. Posaconazole should be used with caution for invasive aspergillosis caused by strains with attenuated posaconazole susceptibility, as drug exposure may be inadequate, resulting in therapeutic failure.
authors.affiliation: Department of Medical Microbiology, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, Netherlands. s.kuipers@mmb.umcn.nl.
authors.forename: Saskia
authors.initials: S
authors.lastname: Kuipers
authors.forename: Roger J M
authors.initials: RJ
authors.lastname: Brüggemann
authors.forename: Ruud G L
authors.initials: RG
authors.lastname: de Sévaux
authors.forename: John P F A
authors.initials: JP
authors.lastname: Heesakkers
authors.forename: Willem J G
authors.initials: WJ
authors.lastname: Melchers
authors.forename: Johan W
authors.initials: JW
authors.lastname: Mouton
authors.forename: Paul E
authors.initials: PE
authors.lastname: Verweij
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000209:etiology; D001232:Aspergillus fumigatus / Q000187:drug effects* / Q000472:pathogenicity*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D014230:Triazoles / Q000627:therapeutic use*
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole