Posaconazole plasma concentrations and invasive mould infection in patients with haematologic malignancies: a cohort study

Ref ID: 17767

Author:

M. Hoenigl*, R. Raggam, T. Valentin, H. Salzer, A. Valentin,
A. Woelfler, K. Seeber, A. Strohmeier, I. Zollner-Schwetz, A. Grisold,
H. Sill, R. Krause

Author address:

Graz, AT)

Full conference title:

22nd European Congress of Clinical Microbiology and Infectious Diseases

Abstract:

Objectives: Posaconazole is a new triazole antifungal agent that has
broad activity against pathogenic fungi and is increasingly used for
prophylaxis and treatment of invasive mould infections (IMI).
Posaconazole is available only as oral formulation with varying
absorption from the gastro-intestinal tract. Reports correlating
posaconazole plasma concentrations (PPCs) with breakthrough IMI,
however, are rare.
Methods: We analyzed posaconazole plasma concentrations (PPCs) in
a prospective observational single-centre study in 2010 and evaluated
correlation of PPCs with breakthrough IMI in patients with
hematological malignancies. We further evaluated risk factors
associated with low PPCs.
Results: A total of 109 PPCs were measured in 34 patients receiving
posaconazole prophylaxis (n = 31) or treatment (n = 3). Insufficient
levels were detected in 24/34 (70%) of patients; in 15 of these 24
patients concentrations were found under the limit of detection
(<0.20 lg/mL). Insufficient PPCs yielded either way in a modification of intake procedures, discontinuation of PPIs or switch of antifungal therapy. In 12 of these 24 cases with insufficient PPC, modification of intake - i.e. with a high fat meal - led to sufficient PPCs. As discontinuation of PPIs led to an improvement of PPC levels in only 1/24 cases, antifungal therapy had to be switched due to insufficient PPCs in another five cases. In three patients with insufficient PPCs, antifungal therapy had to be changed from posaconazole prophylaxis to echinocandin empiric treatment due to development of febrile neutropenia, these patients did not fulfil IFI criteria. Three patients on posaconazole prophylaxis met the criteria of breakthrough infection. Prior to development of invasive fungal infection (IFI), however, PPCs were insufficient in all three patients

Abstract Number: NULL

Conference Year: 2012

Link to conference website: NULL

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