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Who is most at-risk of invasive fungal infections (IFIs)?

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WHO IS MOST AT RISK OF AN INVASIVE FUNGAL INFECTION?

The incidence of invasive fungal infections (IFIs) has been rising over the past decade and is influenced by a number of factors, including the increasing numbers of patients living with compromised immune systems due to the number of transplantations (stem cell and solid organ), targeted treatments for haematological malignancies, and HIV/AIDS.1-6

WHAT CONDITIONS, PROCEDURES AND MEDICATIONS COULD INCREASE IFI RISK?

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Underlying conditions

Uncontrolled diabetes,7 hospitalisation as a result of COVID-19,8,9 nosocomial bacterial infection,2 multiple organ failure,10 burns,11 haematological malignancies2-5 or HIV/AIDS.6

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Invasive and surgical procedures

Major surgery (including intra-abdominal), organ transplantation, life support measures (including mechanical ventilation) or insertion of medical devices (including shunts, catheters and total parenteral nutrition).2 Multiple invasive procedures and prolonged stay in ICU can also increase risk.2,12

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Concomitant or prior medications

Immunosuppressants,2 targeted therapies for haematological malignancies,3-5 corticosteroids and widespread use of broad-spectrum antibiotics.2,13

Increasing worldwide resistance to azoles and echinocandins may also contribute to the rising incidence of IFIs.2,14,15

WHAT FACTORS CAN COMPLICATE AN IFI DIAGNOSIS?

Every day that an IFI goes untreated reduces the chance of survival.16,17 Timely diagnosis can be affected by many different factors:

  • Initial symptoms are often non-specific and similar to those of other conditions such as fever, cough, dyspnoea, hypotension, vomiting and diarrhoea13,18
  • Timely access to diagnostic tools or biomarkers may not be widely available18
  • Tests based on antibody detection have low sensitivity18
  • Culture-based methods may require a long time to yield positive results18

The lack of definitive disease confirmation can delay treatment for patients. Appropriate antifungal treatment should be administered as soon as an IFI is suspected.17,19

AmBisome® (liposomal amphotericin B) is a recommended empirical therapy for presumed IFIs in neutropenic patients who remain persistently febrile despite treatment with broad-spectrum antibiotics.*†20-22
PROBABILITY OF SURVIVAL IN PATIENTS TREATED WITH AMBISOME® (3 MG/KG/DAY)**
Graph showing probability of survival in patients treated with amphotericin B

IN A HIGH-RISK SETTING, PROMPT TREATMENT WITH AMBISOME® IMPROVES CLINICAL OUTCOMES VS. DELAYED TREATMENT23

Using revised European Organisation for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG) definitions, a post-hoc analysis found that initiating AmBisome® (3 mg/kg/day) at the point of suspicion of an IFI (based on pulmonary scan) significantly improved response rates (p=0.006) vs. treating a probable or proven IFI.23

  • Treatment success at end of treatment: 56% (n=62) for possible IFI vs. 40% (n=45) for probable/proven IFI

BE READY FOR WHEN THE NEXT IFI STRIKES

Think IFI particularly in patients presenting with fever who have not responded to broad-spectrum antibiotics.22

Identify your at-risk patients early by looking out for specific risk factors.

Prompt initiation of appropriate broad-spectrum antifungal treatment, even in the absence of a confirmed diagnosis, may reduce mortality risk.1,13,16,17,24-26

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When an IFI strikes in your patients, turn to AmBisome.®22

WHY TREAT EMPIRICALLY WITH AMBISOME®? HEAR WHAT THE EXPERTS HAVE TO SAY

Footnotes

*Recommended by the IDSA guidelines for the management of suspected candidiasis (strong recommendation, moderate-quality evidence) and suspected aspergillosis (strong recommendation, high-quality evidence) in febrile, neutropenic patients and ESCMID-ECMM-ERS guidelines (grading BI).

**Reanalysis of data from the AmBiLoad study - a double-blind study in 339 immunocompromised adults and children with proven or probable invasive aspergillosis or other mould infections (EORTC/MSG criteria) who were randomised (1:1) to receive 1st-line therapy with AmBisome® 3 mg/kg/day or a loading dose of 10 mg/kg/day for the first 14 days and then the standard dose.23,27

AmBisome® is indicated for the empirical treatment of presumed fungal infections in febrile neutropenic patients, where the fever has failed to respond to broad-spectrum antibiotics and appropriate investigations have failed to define a bacterial or viral cause.22

References

  • Chatelon J et al. Adv Ther. 2019;36(12):3308–3320.
  • Bongomin F et al. J Fungi (Basel). 2017;3(4):57.
  • Pagano L et al. Blood Rev. 2017;31(2):17-29.
  • Pagano L and Mayor S. Future Sci OA. 2018;14;4(6):FSO307.
  • Fracchiolla NS et al. PLoS One. 2019;9;14(5):e0216715.
  • Azar M and Hage CD. Clin Chest Med. 2017;38(3):403-415.
  • John TM et al. J Fungi. 2021;7(4):298.
  • Gangneux JP et al. J Mycol Méd. 2020;30:100971.
  • Peman J et al. Rev Iberoam Micol. 2020;37(2):41–46.
  • Verma A et al. Open Forum Infect Dis. 2016;4(1):ofw241.
  • Zhou J et al. Burns. 2019;45(5):1164-1171.
  • De Pascale G et al. Curr Opin Crit Care. 2015;21:421–429.
  • Bassetti M et al. Crit Care. 2014;18(8):458.
  • Arendrup MC. Clin Mincrobiol Infect. 2014;20(Suppl 6):42–48.
  • Nett JE and Andes DR. Infect Dis Clin North Am. 2016;30:51–83.
  • Morrell M et al. Antimicrob Agents Chemother. 2005;49(9):3640–3645.
  • Pappas PG et al. Nat Rev Dis Primers. 2018;4:18026.
  • Falci D et al. Infect Dis Ther. 2017;6:213–223.
  • Lass-Flörl C et al. Antimicrob Agents Chemother. 2008;52(10):3637–3641.
  • IDSA guidelines for the management of candidiasis (2016). Pappas PG et al. Clin Infect Dis. 2016;62(4):e1–e50.
  • ESCMID-ECMM-ERS aspergillosis guidelines 2017. Ullmann AJ et al. Clin Microbiol Infect. 2018;24:e1–e38.
  • AmBisome® Summary of Product Characteristics (UK). Available at: https://www.medicines.org.uk/emc/product/1022/smpc#gref. [Last accessed: April 2022].
  • Cornely OA et al. Mycoses. 2011;54(5):e449–e455.
  • Chandrasekar P. J Antimicrob Chemother. 2011;66(3):457–465.
  • Tashiro M et al. J Infect Chemother. 2021;27:1471–1476.
  • Nivoix Y et al. Clin Infect Dis. 2008;47(9):1176–1184.
  • Cornely OA et al. Clin Infect Dis. 2007;44(10):1289–1297.

Date of preparation: April 2022. Job code: IHQ-AMB-0430.