This Article Full Text Full Text (PDF) Other Versions of this Article: AAC.01388-07v1 52/5/1743    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints and Permissions Copyright Information Books from ASM Press MicrobeWorld Google Scholar Articles by Troke, P. PubMed PubMed Citation Articles by Troke, P.

 Previous Article  |  Next Article 

Antimicrobial Agents and Chemotherapy, May 2008, p. 1743-1750, Vol. 52, No. 5
0066-4804/08/$08.00+0     doi:10.1128/AAC.01388-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Treatment of Scedosporiosis with Voriconazole: Clinical Experience with 107 Patients

The Old Court, Broadstairs, Kent, United Kingdom,¹ Hospital de Cruces, Baracaldo Vizcaya, Spain,² Pfizer Inc., New York, New York,³ Women's and Children's Hospital, Adelaide, Australia,⁴ Royal Perth Hospital, Perth, Australia,⁵ University of Tartu, Tartu, Estonia,⁶ Hematology Hospital Clinic, Barcelona, Spain,⁷ St. Vincent's Hospital, Sydney, Australia,⁸ Peter MacCallum Cancer Centre, Melbourne, Australia,⁹ Westmead Hospital, Sydney, Australia,¹⁰

Received 26 October 2007/ Returned for modification 29 December 2007/ Accepted 10 January 2008

The efficacy of voriconazole in 107 patients with scedosporiosis was analyzed. Principal infection sites were the lungs/sinuses (24%), central nervous system (CNS) (20%), and bone (18%), while 21% of patients had disseminated infection. Solid organ transplantation (22%), hematological malignancy (21%), and surgery/trauma (15%) were the predominant underlying conditions. A successful therapeutic response was achieved in 57% of patients (median, 103 therapy days), with >98% of those responding receiving 28 days of therapy. Patients receiving primary therapy showed a 61% response versus 56% for the others. The best therapeutic responses were seen for skin/subcutaneous (91%) or bone (79%) infections, and the lowest for CNS infections (43%). Patients without major immune suppression (72%) or those with solid organ transplantation (63%) or various hematological conditions (60%) showed the best responses by underlying condition. Median known survival time was 133 days (therapy successes, 252 days; failures, 21 days). In all, 43 (40%) patients died, 73% due to scedosporiosis. Patients with Scedosporium prolificans infection had significantly reduced survival times (P = 0.0259) and were more likely to die from fungal infection (P = 0.002) than were Scedosporium apiospermum-infected patients. In a subset of 43 patients where voriconazole baseline MICs were available, response to voriconazole was higher for S. apiospermum-infected patients (54% response; MIC₅₀, 0.25 µg/ml) than for S. prolificans-infected patients (40% response; MIC₅₀, 4.0 µg/ml). Voriconazole demonstrated clinically useful activity in the treatment of both S. apiospermum and S. prolificans infections and was well tolerated.

Published ahead of print on 22 January 2008.