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oai:repisalud.isciii.es:20.500.12105/165302024-11-29T12:41:47Zcom_20.500.12105_2052com_20.500.12105_2051com_20.500.12105_15322col_20.500.12105_19609col_20.500.12105_16990

00925njm 22002777a 4500 dc Peláez-García de la Rasilla, Teresa author Mato-López, Álvaro author Pablos-Puertas, Clara E author González-Huerta, Ana Julia author Gomez-Lopez, Alicia author Mellado, Emilia author Amich, Jorge author 2023-07-30 Invasive aspergillosis (IA) is a major cause of morbidity and mortality in patients receiving allogeneic haematopoieticcell transplantation. The deep immunosuppression and a variety of potential additional complications developed in these patients result in IA reaching mortality rates of around 50-60%. This mortality is even higher when the patients are infected with azole-resistant isolates, demonstrating that, despite the complexity of management, adequate azole treatment can have a beneficial effect. It is therefore paramount to understand the reasons why antifungal treatment of IA infections caused by azole-susceptible isolates is often unsuccessful. In this respect, there are already various factors known to be important for treatment efficacy, for instance the drug concentrations achieved in the blood, which are thus often monitored. We hypothesize that antifungal persistence may be another important factor to consider. In this study we present two case reports of haematological patients who developed proven IA and suffered treatment failure, despite having been infected with susceptible isolates, receiving correct antifungal treatment and reaching therapeutic levels of the azole. Microbiological analysis of the recovered infective isolates showed that the patients were infected with multiple strains, several of which were persisters to voriconazole and/or isavuconazole. Therefore, we propose that azole persistence may have contributed to therapeutic failure in these patients and that this phenomenon should be considered in future studies. J Fungi (Basel). 2023 Jul 30;9(8):805. 10.3390/jof9080805 2309-608X Journal of fungi (Basel, Switzerland) 37623576 http://hdl.handle.net/20.500.12105/16530 Invasive aspergillosis Aspergillus fumigatus Treatment failure Azole persistence Polygenomic infections Potential Implication of Azole Persistence in the Treatment Failure of Two Haematological Patients Infected with Aspergillus fumigatus