Imperial College London
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DrAnandShah

Faculty of Medicine, School of Public Health

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

s.anand

 
 
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Location

 

Fulham RoadRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@article{Nwankwo:2022:10.20944/preprints202202.0194.v1,
author = {Nwankwo, L and Gilmartin, D and Matharu, S and Nuh, A and Donovan, J and Armstrong-James, D and Shah, A},
doi = {10.20944/preprints202202.0194.v1},
title = {Experience of Isavuconazole as Salvage Therapy in Chronic Pulmonary Fungal Disease},
url = {http://dx.doi.org/10.20944/preprints202202.0194.v1},
year = {2022}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - <jats:p>Background: The burden of resistant fungal infection is rising in patients with pulmonary disease. Options for antifungal therapy are limited, and the only orally-available antifungals, the triazoles, demonstrate inter and intra-patient variability, non-linear kinetics, toxicity, drug interactions and increasing antifungal resistance. Therapeutic drug monitoring (TDM) of itraconazole, voriconazole and posaconazole has been necessary to ensure their safety and efficacy, but is considered unnecessary for the newest triazole isavuconazole, use of which is increasing. Aims: To characterise isavuconazole susceptibility of Aspergillus fumigatus isolates in a tertiary respiratory referral centre to understand prevalence of isavuconazole antimicrobial resistance. To retrospectively review experience of isavuconazole use in this setting, assessing tolerability and therapeutic drug monitoring. Methods: A retrospective observational analysis of adult patients with respiratory disease in a tertiary hospital setting between Sept 2016 and Aug 2021. Clinical cultures were collected and triazole Minimum inhibitory concentration (MIC) were recorded (based on Clinical &amp;amp; Laboratory Standards Institute (CLSI method)). Isavuconazole trough drug levels were carried out as part of the standard of care. Clinical outcomes of treatment were evaluated, along with drug tolerance and TDM. Results: During the study period, isavuconazole susceptibility testing was performed on 26 Aspergillus spp isolates. 80.8% of Aspergillus fumigatus isolates were non-wild type and had isavuconazole MIC &amp;gt; 1mg/L, and 73.0% had MIC above the EUCAST (European Committee on Antimicrobial Susceptibility Testing) epidemiological cut-off (ECOFF) of 2mg/L. There was good correlation between isavuconazole MIC and voriconazole MIC (r =0.7, p=0.0002). 54 patients had isavuconazole therapy over the study period with a median duration of 7.7 months (IQR 0.79 - 16.42). 67% of patie
AU  - Nwankwo,L
AU  - Gilmartin,D
AU  - Matharu,S
AU  - Nuh,A
AU  - Donovan,J
AU  - Armstrong-James,D
AU  - Shah,A
DO  - 10.20944/preprints202202.0194.v1
PY  - 2022///
TI  - Experience of Isavuconazole as Salvage Therapy in Chronic Pulmonary Fungal Disease
UR  - http://dx.doi.org/10.20944/preprints202202.0194.v1
ER  -
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