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Invasive fungal infections in the ICU

A significant proportion of invasive aspergillosis and mucormycosis cases are diagnosed or treated in the ICU1,2

Invasive aspergillosis and mucormycosis typically affect individuals who are immunocompromised and/or have established risk factors,1–5 but cases are also being reported in critically ill patients admitted to the ICU.2–4 In fact, almost half of all cases of invasive aspergillosis and a high proportion of mucormycosis cases are diagnosed or treated in the critical care setting.1,2

The impact of invasive fungal infections in the ICU

Unusual suspects

Invasive fungal infections continue to pose a significant threat to patients and are associated with extremely high mortality.6-9 Early diagnosis and prompt administration of antifungal therapy are key to improving patient outcomes, including survival.10-12
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ICU patients that present with invasive fungal infections may be mildly immunocompromised, or even have no immunosuppression or underlying diseases at all.4,13 This is in contrast to classic diagnostic definitions (EORTC/MSG), which were developed primarily for patients with cancer or undergoing stem cell or solid organ transplant.3–5,14 The ICU patient population may fall outside of those standard definitions,13–15 adding to the diagnostic complexity in an already challenging environment.

Both acute and chronic conditions can predispose non-neutropenic patients to invasive aspergillosis and mucormycosis.1,13,16–20 For example, around one-fifth of ICU patients with severe influenza and one-sixth of those with severe alcoholic hepatitis develop invasive aspergillosis.16–18 Other conditions that may increase the risk of invasive aspergillosis include COPD, ARDS, and liver cirrhosis,13,19,20 while immunocompetent patients with traumatic wounds may go on to develop mucormycosis.1

Underlying conditions in ICU patients with invasive aspergillosis (n=297)​​​​​​​3

Adapted from reference 3.

Key facts

  • A high proportion of mucormycosis cases (37%) are diagnosed or treated in the ICU1
  • Mortality from invasive fungal infections in the critical care setting can exceed 70%21,22
  • Early diagnosis and prompt management are key23–25

Why choose CRESEMBA® (isavuconazole)?

  • An effective, guidelines-endorsed antifungal therapy26–30
  • In the SECURE registration trial, both survival and overall response rates were non-inferior to voriconazole31
  • Better tolerated than voriconazole, with fewer drug-related AEs (42% [n=109] vs 60% [n=155], p<0.001) and drug-related events leading to discontinuation (8% [n=21] vs 14% [n=35])31
  • Fewer drug-drug interactions than other azoles6,32
  • Simple and reliable dosing with a linear PK profile (up to 600 mg per day), unlike other azoles32–34
  • May be used in patients with renal impairment or mild-to-moderate hepatic impairment without dose adjustments32,a
CRESEMBA® can offer the flexibility you need, so that you can focus on your patient’s underlying condition6,7,31,32
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Explore more

Want more information on CRESEMBA ® (isavuconazole)?

Visit the support and resources section to find our latest videos and materials for CRESEMBA ® 

Visit support and resources

See the clinical data for CRESEMBA® in invasive aspergillosis (SECURE trial)

SECURE data

See the clinical data for CRESEMBA® in mucormycosis (VITAL trial)

VITAL data
a. CRESEMBA® has not been studied in severe hepatic impairment; use in these patients is not recommended unless the potential benefit outweighs the risks (and these patients should be carefully monitored for potential drug toxicity).32

AEs, adverse events; ARDS, acute respiratory distress syndrome; BMT, bone marrow transplant; COPD, chronic obstructive pulmonary disease; EORTC/MSG, European Organization for Research and Treatment of Cancer/Mycosis Study Group; HIV, human immunodeficiency virus; ICU, intensive care unit; PI, Prescribing Information; PK, pharmacokinetics.
​                       
Prescribing Information
Click here for CRESEMBA® (isavuconazole) and Vfend (voriconazole) prescribing information 

References:
  1. Bassetti M and Bouza E. J Antimicrob Chemother 2017;72(Suppl 1):i39–i47.
  2. Bassetti M, et al. Infect Dis Ther 2018;7(1):17–27.
  3. Taccone FS, et al. Crit Care 2015;19:7.
  4. ECDC. Influenza-associated invasive pulmonary aspergillosis, Europe. 2018. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/aspergillus-and-influenza-rapid-risk-assessment-november-2018.pdf Accessed February 2022
  5. Baddley JW. Med Mycol 2011;49(Suppl 1):S7–S12.
  6. Natesan SK and Chandrasekar PH. Infect Drug Resist 2016;9:291–300.
  7. Perfect JR. Nat Rev Drug Discov 2017;16(9):603–616.
  8. Binder U and Lass-Florl C. Mediterr J Hematol Infect Dis 2011;3(1):e20110016.
  9. Low CY and Rotstein C. F1000 Med Rep 2011;3:14.
  10. Trof RJ, et al. Intensive Care Med 2007;33:1694–1703.
  11. do Monte Junior ES, et al. Clin Endosc 2020;53(6):746–749.
  12. Sen M, et al. Indian J Ophthalmol 2021;69(2):244–252.
  13. Delsuc C, et al. Crit Care 2015;19:421.
  14. Bassetti M, et al. Clin Infect Dis 2021;72(Suppl 2):S121–S127.
  15. De Pauw B, et al. Clin Infect Dis 2008;46(12):1813–1821.
  16. Schauwvlieghe AFAD, et al. Lancet Respir Med 2018;6(10):782–792.
  17. Wauters J, et al. Intensive Care Med 2012;38(11):1761–1768.
  18. Gustot T, et al. J Hepatol 2014;60(2):267–274.
  19. Contou D, et al. Ann Intensive Care 2016;6(1):52.
  20. Levesque E, et al. Ann Intensive Care 2019;9(1):31.​​​​​​​
  21. Claustre J, et al. Ann Intensive Care 2020;10:74.
  22. Jestin M, et al. Ann Intensive Care 2021;11:31.
  23. Chamilos G, et al. Clin Infect Dis 2008;47(4):503–509.
  24. Mercier T & Maertens J. J Antimicrob Chemother 2017;72(Suppl. 1);i29–i38.
  25. Balsitis M, et al. Med Mycol Case Rep 2015;15–17.
  26. Tissot F, et al. Haematologica 2017;102(3):433–444.
  27. Ullmann AJ, et al. Clin Microbiol Infect 2018;24(Suppl 1):e1–e38.
  28. Patterson TF, et al. Clin Infect Dis 2016;63(4):e1–e60.
  29. Koehler P, et al. Lancet Infect Dis 2021;21(6):e149–e162.
  30. Rudramurthy SM, et al. Mycoses 2021;64(9):1028–1037.
  31. Maertens JA, et al. Lancet 2016;387(10020):760–769.
  32. CRESEMBA GB Summary of Product Characteristics 2021.
  33. Kaindl T, et al. J Antimicrob Chemother 2018;74(3):761–767.
  34. Schmitt-Hoffmann A, et al. Antimicrob Agents Chemother 2006;50(1):279–285.
PP-CRB-GBR-1488. May 2022

ICU

  • Invasive fungal infections and influenza
  • Invasive fungal infections and COVID-19

Meet Ruth, our hypothetical ICU patient with suspected invasive aspergillosis post influenza

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Download this guide to support your diagnosis and treatment of patients with invasive aspergillosis in the ICU

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