Revista Iberoamericana De Micologia最新文献

{"title":"Clinical insights into invasive aspergillosis among immunosuppressed patients: A single-centre experience from Argentina","authors":"Fernando Riera ,&nbsp;Julieta Carballo ,&nbsp;Carlos Bergallo ,&nbsp;Federico Romero ,&nbsp;Belén Palacio ,&nbsp;Lizet Luque-Aguada ,&nbsp;Marcos Marino ,&nbsp;Jon Salmanton-García","doi":"10.1016/j.riam.2025.01.003","DOIUrl":"10.1016/j.riam.2025.01.003","url":null,"abstract":"<div><h3>Background</h3><div>Invasive aspergillosis poses a significant threat to immunocompromised individuals. Diagnostic criteria incorporating biomarkers and imaging have improved diagnosis, and treatment options have expanded. However, in Argentina, diverse patient demographics and environmental factors add complexity to managing this infection.</div></div><div><h3>Aims</h3><div>This study aims to explore the epidemiology, diagnostic methods, and treatment of invasive aspergillosis in an Argentine hospital setting.</div></div><div><h3>Methods</h3><div>We collected data from patients with suspected invasive aspergillosis at a tertiary care hospital in Central-Northern Argentina. Variables included demographics, underlying conditions, diagnostic criteria, treatment, and outcomes.</div></div><div><h3>Results</h3><div>With a median age of 44.5 years and a 51% of male patients, our institution conducted invasive aspergillosis screenings on 192 patients, many of whom were battling malignancies (90%). One third of them had the infection set as probable or possible. Imaging (31%) and positive microbiological results (16%) were examples of diagnostic evidence. With an overall mortality rate of 15%, half of the patients got antifungal treatment for a median of seven days. Mortality among the diagnosed patients was 22%. Patients without stem-cell transplantation had a high death rate (31%), although this difference was not statistically significant; in patients having pulmonary nodules (15%) the death rate was not statistically significant either. There were no discernible variations in mortality according to the type of treatment received.</div></div><div><h3>Conclusions</h3><div>Our study reveals that invasive aspergillosis remains a significant issue in high-risk patients, and has a notable mortality rate, particularly among those patients with pulmonary nodules. Computed tomography provides a high diagnostic yield.</div></div>","PeriodicalId":21291,"journal":{"name":"Revista Iberoamericana De Micologia","volume":"42 2","pages":"Pages 55-59"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluconazole in combination with compounds of natural and pharmaceutical origin: A study on their antimicrobial activity against Candida auris","authors":"Iñigo de-la-Fuente ,&nbsp;Andrea Guridi ,&nbsp;Guillermo Quindós ,&nbsp;Elena Eraso ,&nbsp;Elena Sevillano","doi":"10.1016/j.riam.2025.05.001","DOIUrl":"10.1016/j.riam.2025.05.001","url":null,"abstract":"<div><h3>Background</h3><div>Candidiasis is a prevalent and clinically significant fungal infection. <em>Candida auris</em> has emerged as an important etiological agent due to its high transmissibility, potential to cause severe infections, and resistance to multiple antifungal drugs. Combining fluconazole with other compounds to achieve additive or synergistic antifungal effects has been proposed as a promising strategy for managing these infections.</div></div><div><h3>Aims</h3><div>This study aimed to evaluate the antifungal effects of fluconazole in combination with seven natural compounds (berberine chloride, caffeic acid phenethyl ester, catechin monohydrate, epigallocatechin gallate, magnolol, osthole, and quercetin hydrate) and seven drugs (amiodarone, amlodipine, budesonide, doxycycline, ibuprofen, minocycline, and tigecycline) against <em>C. auris</em>.</div></div><div><h3>Methods</h3><div>The antifungal activity of fluconazole alone and in combination with selected compounds and drugs was analyzed to identify additive or synergistic interactions against 21 isolates of <em>C. auris</em>. Minimum inhibitory concentrations (MICs) of fluconazole were determined and compared across combinations.</div></div><div><h3>Results</h3><div>Fluconazole combined with magnolol, caffeic acid phenethyl ester, or quercetin hydrate showed additive effects against 38%, 9.5%, and 2% of isolates, respectively, and a synergistic effect with quercetin hydrate in 19% of isolates. Fluconazole MICs were reduced from &gt;64<!--> <!-->μg/mL to 1–16<!--> <!-->μg/mL with magnolol in 19 isolates, to 1–32<!--> <!-->μg/mL with caffeic acid phenethyl ester in 17 isolates, and to 1–2<!--> <!-->μg/mL with quercetin hydrate in 8 isolates.</div></div><div><h3>Conclusions</h3><div>These findings highlight the potential of fluconazole combined with magnolol, caffeic acid phenethyl ester, or quercetin hydrate for managing <em>C. auris</em> infections. Further in vivo studies are warranted to assess their therapeutic applicability.</div></div>","PeriodicalId":21291,"journal":{"name":"Revista Iberoamericana De Micologia","volume":"42 2","pages":"Pages 74-80"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of the nephrotoxicity of liposomal amphotericin B and amphotericin B lipid complex in hematological cancer patients: A multicenter retrospective study","authors":"Susanne Edinger ,&nbsp;Edson Abdala ,&nbsp;Umran Şumeyse Ertürk ,&nbsp;Serhat Çelik ,&nbsp;Leylagül Kaynar ,&nbsp;Ricardo Rabagliati ,&nbsp;Hamid Badali ,&nbsp;Ali Amanati ,&nbsp;Alexis Manuel Holguin Ruiz ,&nbsp;Joseph Meletiadis ,&nbsp;Maria Stamouli ,&nbsp;Jessica Fernandes Ramos ,&nbsp;Alexandre Vargas Schwarzbold ,&nbsp;Juan Pablo Caeiro ,&nbsp;Guillermo N. Giordano ,&nbsp;Maria N. Gamaletsou ,&nbsp;Leonardo Filipetto Ferrari ,&nbsp;Joao Paulo Telles ,&nbsp;Felipe Francisco Tuon ,&nbsp;Luiz Cesar Guarita-Souza","doi":"10.1016/j.riam.2025.04.003","DOIUrl":"10.1016/j.riam.2025.04.003","url":null,"abstract":"<div><h3>Background</h3><div>The incidence rates of acute kidney injury (AKI) associated with amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AMB) are inconsistent across studies.</div></div><div><h3>Aims</h3><div>This study aimed to assess the AKI incidence rates in the largest cohort of patients undergoing ABLC and L-AMB treatment for invasive fungal diseases (IFD) in individuals with hematological cancers.</div></div><div><h3>Methods</h3><div>This was a multicenter, international, retrospective cohort study involving patients treated with either L-AMB or ABLC for IFD. All patients had a diagnosed malignant hematological disease. Various clinical and epidemiological variables were examined, including the concurrent use of nephrotoxic drugs. The primary outcome was the incidence of AKI.</div></div><div><h3>Results</h3><div>A total of 637 patients were included in the study, with 294 patients in the ABLC group and 343 patients in the <span>L</span>-AMB group. The most common diagnosis was acute leukemia (56%), followed by lymphoma (22%). The predominant classification of IFD was probable (43%). ABLC was associated with an increased likelihood of inducing grade 1 and 2 nephrotoxicity compared to L-AMB (<em>p</em> <!-->&lt;<!--> <!-->0.001). Multivariate analysis identified age, vancomycin, and polymyxin use as independent risk factors for AKI. However, serum creatinine levels returned to baseline in 95.3% of patients.</div></div><div><h3>Conclusion</h3><div>Nephrotoxicity associated with L-AMB was lower than that associated with ABLC in patients with hematological cancer. Most AKI cases were mild to moderate and did not have significant short-term impact.</div></div>","PeriodicalId":21291,"journal":{"name":"Revista Iberoamericana De Micologia","volume":"42 2","pages":"Pages 60-65"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From 2012 ESCMID to global 2025 ECMM/ISHAM/ASM Candida guidelines: What are the key differences & practical implications?","authors":"Cornelia Lass-Flörl","doi":"10.1016/j.riam.2025.05.002","DOIUrl":"10.1016/j.riam.2025.05.002","url":null,"abstract":"<div><div>The unity of the global 2025 ECMM/ISHAM/ASM <em>Candida</em> guideline (global <em>Candida</em> 2025 guideline) means a practitioner can find all important topics in one document, whereas in 2012 one had to consult multiple papers for each subgroup. The global <em>Candida</em> 2025 guideline retains echinocandins as the first-line treatment for invasive candidiasis while incorporating new agents – such as rezafungin for once-weekly dosing and novel oral options for resistant infections – to offer more personalized, susceptibility-guided therapy. They also recommend an earlier intravenous-to-oral step-down in stable non-neutropenic patients, and emphasize the need for prompt source control. Additionally, there is a stronger focus on managing emerging resistance (notably with <em>Candida auris</em> and azole-resistant <em>Candida parapsilosis</em>) and tailoring prophylaxis and treatment strategies to local epidemiology and special patient populations. It provides detailed, evidence-graded recommendations using the GRADE system, with explicit sections on emerging pathogens, resistance, antifungal stewardship, and infection control. The global <em>Candida</em> 2025 guideline incorporates broader public health considerations and guidance on resource-limited settings.</div></div>","PeriodicalId":21291,"journal":{"name":"Revista Iberoamericana De Micologia","volume":"42 2","pages":"Pages 81-85"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shift in Candida species causing candidemia: A seven-year study from a university hospital and evaluation of the rise of Candida parapsilosis sensu stricto","authors":"Elif Seren Tanriverdi,&nbsp;Yusuf Yakupogullari ,&nbsp;Yucel Duman ,&nbsp;Mehmet Sait Tekerekoglu ,&nbsp;Baris Otlu","doi":"10.1016/j.riam.2025.04.004","DOIUrl":"10.1016/j.riam.2025.04.004","url":null,"abstract":"<div><h3>Background</h3><div>Candidemia ranks the fourth most prevalent infection in healthcare settings. Notably, non-<em>Candida albicans</em> <em>Candida</em> species, particularly <em>Candida parapsilosis</em>, have experienced a worldwide increase as causative agents of candidemia in recent years.</div></div><div><h3>Aims</h3><div>This study aimed to assess shifts in prevalence and antifungal susceptibility of <em>C. parapsilosis</em> among candidemia-causing species over time, alongside investigating clonal relationships among isolates.</div></div><div><h3>Methods</h3><div>We analyzed <em>Candida</em> species in candidemia episodes from January 2016 to December 2022. MALDI-TOF MS identified <em>Candida</em> isolates at the species level, and the identification of the species within <em>C. parapsilosis</em> complex was achieved via the restriction fragment length polymorphism method. Fluconazole susceptibility testing followed EUCAST guidelines. Clonal relationships among <em>C. parapsilosis</em> isolates were assessed using three methods: AP-PCR, REA-PFGE, and electrophoretic karyotyping.</div></div><div><h3>Results</h3><div>Across a seven-year period, <em>Candida</em> prevalence among all blood cultures was 2.1% (679 cases). The most prevalent <em>Candida</em> species were <em>C. parapsilosis</em> (33.7%), <em>C.</em> <em>albicans</em> (32.7%), <em>Nakaseomyces glabratus</em> (formerly <em>Candida glabrata</em>) (14.4%), and <em>Candida tropicalis</em> (8%). Notably, <em>C. parapsilosis</em> isolation rates increased annually from 2016 to 2022. Fluconazole susceptibility of <em>C. parapsilosis</em> isolates declined over time, with rates decreasing from 100% in 2016 to 72.6% in 2022. Electrophoretic karyotyping exhibited superior discrimination in clonal relationship analysis (<em>D</em> <!-->=<!--> <!-->0.9875).</div></div><div><h3>Conclusions</h3><div>Our findings highlight a concerning trend of increasing fluconazole resistance in <em>C. parapsilosis sensu stricto</em> over the study period. Electrophoretic karyotyping has emerged as a robust method for assessing clonal relationships. While no dominant outbreak isolate was identified, the high clustering rate suggests the potential of <em>C. parapsilosis</em> as a significant nosocomial infection agent in the future.</div></div>","PeriodicalId":21291,"journal":{"name":"Revista Iberoamericana De Micologia","volume":"42 2","pages":"Pages 66-73"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-life experience on the use of isavuconazole in solid organ transplantation","authors":"Jose Tiago Silva ,&nbsp;Amparo Solé ,&nbsp;José María Aguado","doi":"10.1016/j.riam.2025.02.004","DOIUrl":"10.1016/j.riam.2025.02.004","url":null,"abstract":"<div><div>Solid organ transplant (SOT) recipients have a higher risk of developing invasive fungal infection (IFI). Isavuconazole is a novel broad-spectrum azole active against <em>Aspergillus</em> and <em>Mucor</em>. Isavuconazole is well tolerated, shows an excellent bioavailability and predictable pharmacokinetics, good diffusion to tissues, significantly reduced drug–drug interactions with immunosuppressive drugs in comparison with other broad-spectrum azoles, and few serious adverse effects, including hepatic toxicity. We have performed an extensive literature review concerning the clinical experience on the use of isavuconazole in SOT as prophylaxis and treatment of IFI, which included the SOTIS and the ISASOT studies, and fourteen published case reports. Clinical response, all-cause and invasive aspergillosis-attributable mortality in recipients treated with isavuconazole were similar to those described with voriconazole. Drug–drug interactions with immunosuppressive agents were manageable after the adjustment of tacrolimus and mTOR inhibitors. Isavuconazole showed fewer drug-related side effects and a smaller rate of premature discontinuation than voriconazole. In conclusion, isavuconazole appears to be a reasonable option for the treatment of IFI in SOT, and can be an alternative to voriconazole as antifungal prophylaxis in lung transplantation. Nonetheless, more clinical studies are needed.</div></div>","PeriodicalId":21291,"journal":{"name":"Revista Iberoamericana De Micologia","volume":"42 1","pages":"Pages 26-31"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world use of isavuconazole in adult oncohematology patients","authors":"Mi Kwon","doi":"10.1016/j.riam.2025.02.001","DOIUrl":"10.1016/j.riam.2025.02.001","url":null,"abstract":"<div><div>Isavuconazole has emerged as a significant antifungal agent in the treatment and prophylaxis of invasive fungal infections (IFIs) among immunocompromised patients, particularly those undergoing hematopoietic stem cell transplantation (HSCT) or receiving treatment for hematological malignancies. Real-world experience with the use of isavuconazole in oncohematological patients has increasingly been reported. Isavuconazole has demonstrated efficacy against a broad spectrum of fungal pathogens, with a favorable safety profile and lower rates of hepatotoxicity compared to other azoles. Isavuconazole is generally well-tolerated, making it suitable for long-term use in high-risk patients for both treatment and prophylaxis of IFIs. Isavuconazole can be considered a valuable treatment option for IFIs in patients with hematological malignancies and HSCT recipients. It may be a suitable alternative to other azoles, especially in patients with underlying liver dysfunction or those experiencing the effects of multiple drug interactions. Nevertheless, further research is needed to evaluate the long-term safety and efficacy of isavuconazole, particularly in specific patient populations and in combination with other antifungal agents. Overall, isavuconazole represents a promising addition to the antifungal armamentarium, offering a safer and more effective treatment option for patients at high risk of IFIs.</div></div>","PeriodicalId":21291,"journal":{"name":"Revista Iberoamericana De Micologia","volume":"42 1","pages":"Pages 22-25"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosing invasive fungal infections in the laboratory today: It's all good news?","authors":"Javier Pemán ,&nbsp;Alba Ruiz-Gaitán","doi":"10.1016/j.riam.2025.01.004","DOIUrl":"10.1016/j.riam.2025.01.004","url":null,"abstract":"<div><div>Despite the advances in medical science, invasive fungal infections (IFI) remain a diagnostic challenge. The increasing prevalence of IFI, driven by immunosuppressive therapies, advances in intensive care and emerging pathogens, underscores the need for early and accurate diagnosis. This review evaluates current laboratory methods for the diagnosis of IFI, highlighting their strengths and limitations.</div><div>Conventional techniques, including fungal culture, direct microscopy, and histopathology, remain the gold standard for the diagnosis of proven IFIs. These methods allow pathogen isolation, species identification and antifungal susceptibility testing. However, these techniques have limitations in terms of sensitivity and turnaround times. Although microscopy is a rapid technique, its sensitivity and species discrimination profile are limited.</div><div>Modern serological assays, such as β-<span>d</span>-glucan and galactomannan detection, have improved the diagnostic accuracy of probable IFI cases. Integration of these assays with clinical and radiological findings, enables earlier intervention, although this is accompanied by an increased risk of false positives and necessitates careful clinical correlation. Molecular diagnostics, particularly polymerase chain reaction (PCR), allow rapid, species-specific identification directly from clinical samples. The advent of MALDI-TOF mass spectrometry has further improved diagnostic efficiency, particularly for yeast identification, although challenges remain for filamentous fungi.</div><div>Innovative techniques, such as metagenomic sequencing, lateral-flow assays, and loop-mediated isothermal amplification, offer the potential for rapid and precise detection, even in resource-limited settings. The combination of conventional and innovative methods provides a comprehensive diagnostic framework. The continuous refinement of these tools, in conjunction with multidisciplinary collaboration, is imperative to improve the early diagnostic and targeted treatment of patients with IFI.</div></div>","PeriodicalId":21291,"journal":{"name":"Revista Iberoamericana De Micologia","volume":"42 1","pages":"Pages 1-14"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience with isavuconazole in the treatment of mucormycosis and breakthrough fungal infections","authors":"Carolina Garcia-Vidal ,&nbsp;Antonio Gallardo-Pizarro ,&nbsp;Tommaso Francesco Aiello ,&nbsp;Ana Martinez-Urrea ,&nbsp;Christian Teijon-Lumbreras ,&nbsp;Patricia Monzo-Gallo","doi":"10.1016/j.riam.2025.01.005","DOIUrl":"10.1016/j.riam.2025.01.005","url":null,"abstract":"<div><div>Isavuconazole, a triazole-class antifungal, is effective and safe for both primary treatment and salvage therapy in a variety of fungal infections. This article reviews recent knowledge on the role of this antifungal in the treatment of mucormycosis and breakthrough invasive fungal infections (bIFI) during antifungal therapy. Isavuconazole has demonstrated favorable clinical outcomes and a good safety profile in various patient populations with mucormycosis, including those with comorbidities such as diabetes mellitus or severe immunosuppression. Particularly noteworthy is the fact that drug interactions in patients with mucormycosis, where a solid organ transplant was a predisposing factor, have been effectively managed. In the treatment of bIFIs, the use of isavuconazole requires a thoughtful reflection about the fungal species involved and their susceptibility profiles. This is highly dependent on the antifungal agent administered before the onset of bIFI. Early diagnosis and appropriate antifungal therapy are essential to improve outcomes in patients with mucormycosis and bIFIs. Isavuconazole represents a valuable option for managing these complex infections.</div></div>","PeriodicalId":21291,"journal":{"name":"Revista Iberoamericana De Micologia","volume":"42 1","pages":"Pages 51-54"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacokinetic novelties of isavuconazole. Use in special situations","authors":"Francisco Javier Candel ,&nbsp;Mayra Matesanz ,&nbsp;José Mensa ,&nbsp;José Ramón Azanza","doi":"10.1016/j.riam.2025.02.003","DOIUrl":"10.1016/j.riam.2025.02.003","url":null,"abstract":"<div><div>Isavuconazole, a next generation triazole, exhibits unique pharmacokinetic and pharmacodynamic properties that make it ideal for treating invasive fungal infections in critically ill and immunocompromised patients. This antifungal agent stands out for its broad spectrum of activity, which includes filamentous fungi such as <em>Aspergillus</em> and Mucorales, with an efficacy comparable to that of voriconazole and additional advantages against these pathogens. Its high oral bioavailability (close to 100%), prolonged half-life (&gt;100<!--> <!-->h), and linear, predictable pharmacokinetic profile minimize the need for frequent dose adjustments and therapeutic monitoring. Its lipophilic structure facilitates penetration into key tissues, such as the central nervous system and pulmonary tissue, as validated by clinical studies showing survival rates exceeding 70% in patients with complicated invasive fungal infection. Its use is safe in populations with renal impairment, mild to moderate hepatic impairment, paediatrics, and obesity, although dose adjustment is recommended for severe hepatic impairment. Recent studies in critically ill patients undergoing extracorporeal membrane oxygenation or continuous renal replacement therapy have revealed moderate reductions in plasma concentration, without significant clinical impact. Adaptive dosing strategies have been proposed to optimize efficacy in these cases. Compared to other triazoles, isavuconazole demonstrates a robust safety profile, with lower incidences of hepatotoxicity and neurotoxicity. Its antifungal activity, favorable pharmacokinetics, and excellent safety profile underscore its role as a reference antifungal agent, particularly in challenging clinical scenarios.</div></div>","PeriodicalId":21291,"journal":{"name":"Revista Iberoamericana De Micologia","volume":"42 1","pages":"Pages 37-44"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}