Isavuconazole in the Treatment of <i>Aspergillus fumigatus</i> Fracture-Related Infection: Case Report and Literature Review
<i>Aspergillus</i> fracture-related infection (FRI) is a rare, but severe complication in trauma surgery. The optimal antifungal treatment for <i>Aspergillus</i> osteomyelitis, including FRI, has not been established yet, as only cases have been documented and data on bone pe...
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| Format: | Article |
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MDPI AG
2022-03-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/11/3/344 |
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| author | Beatrijs Mertens Ruth Van Daele Melissa Depypere Katrien Lagrou Yves Debaveye Joost Wauters Stefaan Nijs Willem-Jan Metsemakers Isabel Spriet |
| author_facet | Beatrijs Mertens Ruth Van Daele Melissa Depypere Katrien Lagrou Yves Debaveye Joost Wauters Stefaan Nijs Willem-Jan Metsemakers Isabel Spriet |
| author_sort | Beatrijs Mertens |
| collection | DOAJ |
| description | <i>Aspergillus</i> fracture-related infection (FRI) is a rare, but severe complication in trauma surgery. The optimal antifungal treatment for <i>Aspergillus</i> osteomyelitis, including FRI, has not been established yet, as only cases have been documented and data on bone penetration of antifungal drugs are scarce. We describe a patient with <i>Aspergillus fumigatus</i> FRI of the tibia who was treated with isavuconazole after developing liver function disturbances during voriconazole therapy. Isavuconazole, the active moiety formed after hydrolysis of the prodrug isavuconazonium sulfate by plasma esterases, was administered in a maintenance dose of 200 mg q24 h, followed by 150 mg q24 h. The patient completed a six-month antifungal treatment course. Although fracture union was not achieved during six months of follow-up after therapy cessation, no confirmatory signs of FRI were observed. Additionally, two literature searches were conducted to review available data on antifungal treatment of <i>Aspergillus</i> osteomyelitis and bone penetration of antifungals. One hundred and eight cases of <i>Aspergillus</i> osteomyelitis, including six (5.6%) FRI cases, were identified. Voriconazole and (lipid formulations of) amphotericin B were the most commonly used antifungals. In three (2.8%) cases isavuconazole was prescribed as salvage therapy. Data on antifungal bone penetration were reported for itraconazole, voriconazole, amphotericin B, anidulafungin and 5-fluorocytosin. Isavuconazole might be a promising alternative for the treatment of <i>Aspergillus</i> osteomyelitis. However, standardized case documentation is needed to evaluate the efficacy of isavuconazole and other antifungals in the treatment of <i>Aspergillus</i> osteomyelitis, including FRI. |
| first_indexed | 2024-03-09T20:12:46Z |
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| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-09T20:12:46Z |
| publishDate | 2022-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-94949f8e8a844ca098a862226ce3310d2023-11-24T00:11:00ZengMDPI AGAntibiotics2079-63822022-03-0111334410.3390/antibiotics11030344Isavuconazole in the Treatment of <i>Aspergillus fumigatus</i> Fracture-Related Infection: Case Report and Literature ReviewBeatrijs Mertens0Ruth Van Daele1Melissa Depypere2Katrien Lagrou3Yves Debaveye4Joost Wauters5Stefaan Nijs6Willem-Jan Metsemakers7Isabel Spriet8Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, B-3000 Leuven, BelgiumDepartment of Pharmaceutical and Pharmacological Sciences, KU Leuven, B-3000 Leuven, BelgiumClinical Department of Laboratory Medicine, University Hospitals Leuven, B-3000 Leuven, BelgiumClinical Department of Laboratory Medicine, University Hospitals Leuven, B-3000 Leuven, BelgiumDepartment of Cellular and Molecular Medicine, KU Leuven, B-3000 Leuven, BelgiumClinical Department of Laboratory Medicine, University Hospitals Leuven, B-3000 Leuven, BelgiumDepartment of Development and Regeneration, KU Leuven, B-3000 Leuven, BelgiumDepartment of Development and Regeneration, KU Leuven, B-3000 Leuven, BelgiumDepartment of Pharmaceutical and Pharmacological Sciences, KU Leuven, B-3000 Leuven, Belgium<i>Aspergillus</i> fracture-related infection (FRI) is a rare, but severe complication in trauma surgery. The optimal antifungal treatment for <i>Aspergillus</i> osteomyelitis, including FRI, has not been established yet, as only cases have been documented and data on bone penetration of antifungal drugs are scarce. We describe a patient with <i>Aspergillus fumigatus</i> FRI of the tibia who was treated with isavuconazole after developing liver function disturbances during voriconazole therapy. Isavuconazole, the active moiety formed after hydrolysis of the prodrug isavuconazonium sulfate by plasma esterases, was administered in a maintenance dose of 200 mg q24 h, followed by 150 mg q24 h. The patient completed a six-month antifungal treatment course. Although fracture union was not achieved during six months of follow-up after therapy cessation, no confirmatory signs of FRI were observed. Additionally, two literature searches were conducted to review available data on antifungal treatment of <i>Aspergillus</i> osteomyelitis and bone penetration of antifungals. One hundred and eight cases of <i>Aspergillus</i> osteomyelitis, including six (5.6%) FRI cases, were identified. Voriconazole and (lipid formulations of) amphotericin B were the most commonly used antifungals. In three (2.8%) cases isavuconazole was prescribed as salvage therapy. Data on antifungal bone penetration were reported for itraconazole, voriconazole, amphotericin B, anidulafungin and 5-fluorocytosin. Isavuconazole might be a promising alternative for the treatment of <i>Aspergillus</i> osteomyelitis. However, standardized case documentation is needed to evaluate the efficacy of isavuconazole and other antifungals in the treatment of <i>Aspergillus</i> osteomyelitis, including FRI.https://www.mdpi.com/2079-6382/11/3/344fracture-related infectionosteomyelitis<i>Aspergillus</i>invasive aspergillosisantifungal treatmentisavuconazole |
| spellingShingle | Beatrijs Mertens Ruth Van Daele Melissa Depypere Katrien Lagrou Yves Debaveye Joost Wauters Stefaan Nijs Willem-Jan Metsemakers Isabel Spriet Isavuconazole in the Treatment of <i>Aspergillus fumigatus</i> Fracture-Related Infection: Case Report and Literature Review Antibiotics fracture-related infection osteomyelitis <i>Aspergillus</i> invasive aspergillosis antifungal treatment isavuconazole |
| title | Isavuconazole in the Treatment of <i>Aspergillus fumigatus</i> Fracture-Related Infection: Case Report and Literature Review |
| title_full | Isavuconazole in the Treatment of <i>Aspergillus fumigatus</i> Fracture-Related Infection: Case Report and Literature Review |
| title_fullStr | Isavuconazole in the Treatment of <i>Aspergillus fumigatus</i> Fracture-Related Infection: Case Report and Literature Review |
| title_full_unstemmed | Isavuconazole in the Treatment of <i>Aspergillus fumigatus</i> Fracture-Related Infection: Case Report and Literature Review |
| title_short | Isavuconazole in the Treatment of <i>Aspergillus fumigatus</i> Fracture-Related Infection: Case Report and Literature Review |
| title_sort | isavuconazole in the treatment of i aspergillus fumigatus i fracture related infection case report and literature review |
| topic | fracture-related infection osteomyelitis <i>Aspergillus</i> invasive aspergillosis antifungal treatment isavuconazole |
| url | https://www.mdpi.com/2079-6382/11/3/344 |
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