title: Breakthrough invasive fungal diseases during voriconazole treatment for aspergillosis: A 5-year retrospective cohort study.
abstract: Breakthrough invasive fungal diseases (bIFDs) during voriconazole treatment are concerning, as they are associated with high rates of mortality and pathogen distribution. To evaluate the prevalence, incidence, patient characteristics, including IFD events, and overall mortality of bIFDs during voriconazole treatment for invasive aspergillosis (IA). We retrospectively analyzed the medical records of consecutive patients who had undergone voriconazole treatment for IA and who had bIFD events between January 2011 and December 2015. Eleven bIFD events occurred in 9 patients. The prevalence and incidence of bIFDs were 2.25% (9/368) and 0.22 cases per year, respectively. Overall mortality was 44.4% (4/9). The severity of the illness and persistence of immunodeficiency, mixed infection, and low concentration of the treatment drug at the site of infection were identified as possible causes of bIFDs. Seven of 11 events (63.6%) required continued voriconazole treatment with drug level monitoring. In 4 (36.3%) cases, the treatment was changed to liposomal amphotericin B. Two cases resulted in surgical resection (18.2%). Clinicians should be aware that bIFDs during voriconazole treatment for IA can occur, and active therapeutic approaches are required in these cases.
authors: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors: Sun Bean
authors: SB
authors: Kim
authors: Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors: Sung-Yeon
authors: SY
authors: Cho
authors: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.|The Catholic Blood and Marrow Transplantation Centre, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors: Dong-Gun
authors: DG
authors: Lee
authors: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors: Jae-Ki
authors: JK
authors: Choi
authors: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors: Hyo-Jin
authors: HJ
authors: Lee
authors: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors: Si-Hyun
authors: SH
authors: Kim
authors: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors: Sun Hee
authors: SH
authors: Park
authors: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors: Su-Mi
authors: SM
authors: Choi
authors: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors: Jung-Hyun
authors: JH
authors: Choi
authors: Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.|Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors: Jin-Hong
authors: JH
authors: Yoo
authors: The Catholic Blood and Marrow Transplantation Centre, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors: Jong-Wook
authors: JW
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001230:Aspergillus / Q000187:drug effects*; D025141:Drug Resistance, Fungal; D005260:Female; D006801:Humans; D015994:Incidence; D055744:Invasive Pulmonary Aspergillosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D016019:Survival Analysis; D065819:Voriconazole / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B; D065819:Voriconazole
keywords: Aspergillosis; Breakthrough invasive fungal disease; Mycoses; Voriconazole