Table 4.
Systemic Antifungal Therapy After Invasive Mold Infection Diagnosis
| Antifungal Treatment | All IMI (n = 131) | Aspergillosisa (n = 98) | Mucormycosisa (n = 17) | Other Molda (n = 22) |
|---|---|---|---|---|
| Initial therapy | No (%) | |||
| Monotherapy | 97 (74)b | 76 (78) | 12 (71) | 14 (64)b |
| Triazole | 49 (37) | 42 (43) | 4 (24) | 6 (27) |
| Voriconazole | 45 (34) | 39 (40) | 2 (12) | 5 (23) |
| Posaconazole | 3 (2) | 2 (2) | 2 (12) | 1 (5) |
| Itraconazole | 1 (1) | 1 (1) | 0 | 0 |
| Polyene | 40 (31) | 30 (31) | 7 (41) | 4 (18) |
| Echinocandin | 8 (6) | 4 (4) | 1 (6) | 4 (18) |
| Combination therapyc | 33 (25)b | 22 (22) | 5 (29) | 7 (32)b |
| Triazole/polyene | 19 (15) | 13 (13) | 3 (18) | 4 (18) |
| Triazole/echinocandin | 9 (7) | 7 (7) | 0 | 2 (9) |
| Polyene/echinocandin | 2 (2) | 1 (1) | 1 (6) | 0 |
| Triazole/polyene/echinocandin | 3 (2) | 1 (1) | 1 (6) | 1 (5) |
| Therapy 12 wks after diagnosis | No (%) | |||
| Triazole | 107 (82) | 84 (86) | 10 (59) | 18 (82) |
| Voriconazoled | 95 (73) | 80 (82) | 4 (24) | 14 (64) |
| Posaconazolee | 22 (17) | 8 (8) | 7 (41) | 10 (45) |
| Itraconazole | 1 (1) | 1 (1) | 0 | 0 |
| Polyenef | 83 (63) | 58 (59) | 14 (82) | 14 (64) |
| Echinocanding | 51 (39) | 39 (40) | 4 (24) | 9 (41) |
| Terbinafine | 1 (1) | 0 | 0 | 1 (5) |
| Combination therapyc | 70 (53) | 53 (54) | 7 (41) | 12 (55) |
| Triazole/polyene | 37 (28) | 27 (28) | 4 (24) | 8 (36) |
| Triazole/echinocandin | 36 (27) | 31 (32) | 1 (6) | 5 (23) |
| Polyene/echinocandin | 11 (8) | 8 (8) | 2 (12) | 1 (5) |
| Triazole/polyene/echinocandin | 10 (8) | 6 (6) | 1 (6) | 3 (14) |
| Otherh | 6 (5) | 3 (3) | 1 (6) | 3 (14) |
Abbreviations: IMI, invasive mold infection; IQR, interquartile range.
aCategories are not mutually exclusive: 5 patients with mixed infections were included in multiple categories.
bInitial monotherapy and initial combination therapy groups do not add up to total because 1 participant with Fusarium did not receive treatment due to death near the time of diagnosis.
cCombination therapy is defined as overlap of 2 or more agents for at least 3 days. Some patients received multiple types of combination therapy during the 12 weeks after diagnosis.
dMedian voriconazole starting dose 12.2 mg/kg per day (IQR, 9.8–14.3 mg/kg per day) for patients <12 years old, 400 mg/day (IQR, 400–560 mg/day) for patients ≥12 years old. Sixty-four (67%) started therapy with oral formulation.
eMedian posaconazole starting dose 20.8 mg/kg per day (IQR, 17.9–26.0 mg/kg per day) for patients <12 years old, 800 mg/day for all but 1 participant ≥12 years.
fOf 83 patients who received polyenes, 75 (90%) received liposomal amphotericin B, with median starting dose 5.0 mg/kg per day (IQR, 3.1–5.3 mg/kg per day).
gMedian starting doses: caspofungin, 50 mg/m2 per day (IQR, 49.1–73.4 mg/m2 per day) in patients <12 years old, 50 mg/day in all patients ≥12 years old; micafungin, 3.1 mg/kg per day (IQR, 2.9–4.4 mg/kg per day) in patients <12 years old, 150 mg/day (IQR, 110–175 mg/day) in patients ≥12 years old.
hOther combination regimens used were as follows: voriconazole and posaconazole in 1 participant with aspergillosis; voriconazole, posaconazole and micafungin in 1 participant with aspergillosis; liposomal amphotericin B, voriconazole, and posaconazole in 1 participant with aspergillosis and mucormycosis (unknown species) and 1 participant with Exserohilum spp; liposomal amphotericin B and terbinafine 1 participant with Fusarium; and liposomal amphotericin B, voriconazole, posaconazole, and micafungin in 1 participant with Exserohilum spp.