When to change treatment of acute invasive aspergillosis: an expert viewpoint

Monica A. Slavin*, Yee Chun Chen, Catherine Cordonnier, Oliver A. Cornely, Manuel Cuenca-Estrella, J. Peter Donnelly, Andreas H. Groll, Olivier Lortholary, Francisco M. Marty, Marcio Nucci, John H. Rex, Bart J.A. Rijnders, George R. Thompson, Paul E. Verweij, P. Lewis White, Ruth Hargreaves, Emma Harvey, Johan A. Maertens

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Invasive aspergillosis (IA) is an acute infection affecting patients who are immunocompromised, as a result of receiving chemotherapy for malignancy, or immunosuppressant agents for transplantation or autoimmune disease. Whilst criteria exist to define the probability of infection for clinical trials, there is little evidence in the literature or clinical guidelines on when to change antifungal treatment in patients who are receiving prophylaxis or treatment for IA. To try and address this significant gap, an advisory board of experts was convened to develop criteria for the management of IA for use in designing clinical trials, which could also be used in clinical practice. For primary treatment failure, a change in antifungal therapy should be made: (i) when mycological susceptibility testing identifies an organism from a confirmed site of infection, which is resistant to the antifungal given for primary therapy, or a resistance mutation is identified by molecular testing; (ii) at, or after, 8 days of primary antifungal treatment if there is increasing serum galactomannan, or galactomannan positivity in serum, or bronchoalveolar lavage fluid when the antigen was previously undetectable, or there is sudden clinical deterioration, or a new clearly distinct site of infection is detected; and (iii) at, or after, 15 days of primary antifungal treatment if the patient is clinically stable but with ≥2 serum galactomannan measurements persistently elevated compared with baseline or increasing, or if the original lesions on CT or other imaging, show progression by >25% in size in the context of no apparent change in immune status.

Original languageEnglish
Pages (from-to)16-23
Number of pages8
JournalThe Journal of antimicrobial chemotherapy
Issue number1
Early online date11 Sep 2021
Publication statusPublished - Jan 2022

Bibliographical note

F2G Ltd funded the advisory board, provided travel and accommodation
costs, as well as providing an honorarium according to global, national
and local regulations for the time spent at the workshop and for completing the pre- and post-meeting questionnaires. None of the authors
was paid for writing or reviewing this paper.
Professional editing assistance (provided by Patricia Ingram) was
funded by F2G Ltd.

Publisher Copyright:
© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.


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