Over the past year there have been a number of significant developments. Firstly, in antifungal therapy Posaconazole, a new triazole antifungal, has been licensed for use. The findings of two large randomised studies of antifungal prophylaxis with Posaconazole indicate that it has an important role for prevention of invasive aspergillosis in high risk neutropenic and stem cell transplant patients. It also is active in zygomycosis for which there are few therapeutic options. Anidulafungin and Micafungin are new members of the echinocandin class with good clinical efficacy in candidaemia, but also activity against Aspergillus spp. The EORTC-MSG definitions of invasive fungal infections (IFI) are being revised and will soon be published. These were initially developed as a research tool and have been successfully used in subsequent clinical trials. Diagnosis of IFI continues to be a challenge, often relying on CT imaging and clinical criteria, with mixed results from molecular diagnostics although some new approaches are under investigation. There is some concern that while the epidemiology of candidiasis remains more or less consistent, there has been an increase in non-Aspergillus mould infections in particular risk groups such as leukaemia therapy patients. Several US centres report a link between increasing use of Voriconazole and a corresponding increase in cases of zygomycosis. All the above underlines the need for good mycological support from Microbiology laboratories and ongoing audit of fungal infections. To this end the launch of the British Society for Medical Mycology UK Fungal Registry will offer a valuable support tool, while the BSMM/UCL MSc in Medical Mycology should have its first graduates this year.
Full conference title:
Federation of Infection Societies
- FIS (2007)