Triggers for driving treatment of at-risk patients with invasive fungal disease

Luboš Drgona*, Anca Colita, Nikolay Klimko, Galia Rahav, Mehmet A. Ozcan, J. Peter Donnelly

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Timing of treatment for invasive fungal disease (IFD) is critical for making appropriate clinical decisions. Historically, many centres have treated at-risk patients prior to disease detection to try to prevent fungal colonization or in response to antibiotic-resistant fever. Many studies have indicated that a diagnostic-driven approach, using radiological tests and biomarkers to guide treatment decisions, may be a more clinically relevant and cost-effective approach. The Invasive Fungal Infections Cooperative Group of the European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) defined host clinical andmycological criteria for proven, probable and possible classes of IFD, to aid diagnosis. However, some patients at risk of IFD do not meet EORTC/MSG criteria and have been termed Groups B (patients with persistent unexplained febrile neutropenia) and C (patients with non-definitive signs of IFD) in a study by Maertens et al. (Haematologica 2012; 97: 325-7). Consequently, we considered the most appropriate triggers (clinical or radiological signs or biomarkers) for treatment of all patient groups, especially the unclassified B and Cgroups, based on our clinical experience. ForGroup C patients, additional diagnostic testing is recommended before a decision to treat, including repeat galactomannan tests, radiological scans and analysis of bronchoalveolar lavage fluid. Triggers for stopping antifungal treatment were considered to include resolution of all clinical signs and symptoms. ForGroup B patients, itwas concluded that better definition of risk factors predisposing patients to fungal infection and the use of more sensitive diagnostic tests are required to aid treatment decisions and improve clinical outcomes.

Original languageEnglish
Article numberdkt391
Pages (from-to)iii17-iii24
JournalJournal of Antimicrobial Chemotherapy
Issue numberSUPPL3
StatePublished - 2013
Externally publishedYes


  • Diagnostic-driven therapy
  • Galactomannan test
  • Immunocompromised patients
  • Radiological triggers


Dive into the research topics of 'Triggers for driving treatment of at-risk patients with invasive fungal disease'. Together they form a unique fingerprint.

Cite this