Current evidence for the treatment of invasive fungal infections in immunocompromised patients

Author(s): Jutta Auberger, Cornelia Lass-Flori

Invasive fungal infections (IFIs) remain a leading cause of morbidity and mortality in immunocompromised patients. Among those, patients with hematological malignancies and those who have undergone solid organ or allogeneic hematopoietic stem cell transplantation are at particularly high risk. Species of Candida and Aspergillus remain the most common causes of IFIs; however, other yeasts and filamentous fungi are emerging as significant pathogens. The sensitive and specific diagnosis remains difficult in many cases and early initiation of treatment is mandatory to improve survival. Although major improvements have been made, it often remains difficult to obtain diagnosis in neutropenic patients and treatment of IFIs in this high-risk population remains challenging. A growing armamentarium of novel antifungal agents has been approved in recent years. ‘Old fashioned’ amphotericin B deoxycholate (D-AMB) has been replaced with lipid formulations and new-generation triazoles, as well as novel class echinocandins, which finally offer opportunities to improve prognosis with the convenient side-effect of better tolerability. Clinical decision-making depends on several guidelines, published studies and not least on economic considerations. Future approaches should be directed towards enhanced diagnostic methods and, thus, allow for timely and effective tailor-made use of antifungals.