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AboutAbout  CRESEMBA®Invasive fungal infections and risk factorsMeet CRESEMBA ®CRESEMBA® patient profilesVirtual Patient ExperienceEfficacyEfficacyInvasive AspergillosisMucormycosis

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LabelDosingDosingDosingSafety ProfileSafety & TolerabilitySafety ProfileEmerging PopulationsEmerging PopulationsICUInvasive fungal infections in the ICUInvasive fungal infections and influenza

Invasive fungal infections in solid organ transplant recipients

Invasive fungal infections and chronic obstructive pulmonary disease

Invasive fungal infections and COVID-19 (CAPA/CAM)Support & ResourcesResourcesKOL VideosNational/Regional GuidelinesECIL-6 Guidelines
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Information on how to access prescribing information and adverse event reporting can be found towards the bottom of the page.

Invasive fungal infections in the ICUThe impact of invasive fungal infections in the ICUUnderlying conditions in ICU patients

Invasive aspergillosis and mucormycosis are serious opportunistic infections associated with high mortality.1–5

They typically affect individuals who are immunocompromised and/or have established risk factors or underlying conditions such as malignancies, neutropenia and transplants, certain medications and/or environmental factors.6–9

However, the epidemiology of invasive aspergillosis is evolving, and cases have been reported patients without the classical host risk factors, including critically ill patients admitted to the ICU.9
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.10,11

Underlying conditions in ICU patients with invasive aspergillosis (n=297)9

Adapted from reference 9.

Emerging populations in the ICUIn the ICU patient population, information about the incidence of invasive aspergillosis is starting to emerge.9,10,12  Both acute and chronic conditions can predispose non-neutropenic patients to invasive aspergillosis and mucormycosis.10,13–19 For example, around one-fifth of ICU patients with severe influenza and one-sixth of those with severe alcoholic hepatitis develop invasive aspergillosis.13–15  Other conditions that may increase the risk of invasive aspergillosis include COPD, ARDS, and liver cirrhosis,17–19 while immunocompetent patients with traumatic wounds may go on to develop mucormycosis.10 How many critically ill patients develop invasive aspergillosis in the ICU?a

a. Cases of invasive aspergillosis (mainly pulmonary) reported among ICU patients in different prospective and retrospective studies. 

Diagnosis in the ICUInvasive fungal infections continue to pose a significant threat to patients and are associated with extremely high mortality.20–23 Early diagnosis and prompt administration of antifungal therapy are key to improving patient outcomes, including survival.24–26 ICU patients that present with invasive fungal infections may be mildly immunocompromised, or even have no immunosuppression or underlying diseases at all.12,19 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.8,9,12,27 The ICU patient population may fall outside of those standard definitions,19,27,28 adding to the diagnostic complexity in an already challenging environment. EORTC/MSG definitions can be complicated to extrapolate for critically ill patients for a number of reasons:29 In addition, non-neutropenic patients tend to be less symptomatic than neutropnic ones in terms of fever, cough and chest pain.6 

As a consequence, clinical suspicion of invasive fungal infections is often low for non-neutropenic patients causing potentially fatal delays in diagnostics and treatment.6
Prompt diagnostic testing can support in identifying patients with invasive fungal infections in the ICU, inlcuding those with less defined risk factors6,19,28,29
Learn more about diagnostics for fungal infectionsLoadingExplore more
Want more information on CRESEMBA® (isavuconazole)?
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ARDS, acute respiratory distress syndrome; BMT, bone marrow transplant; COPD, chronic obstructive pulmonary disease; COVID-19, coronavirus disease-2019; EORTC/MSG, European Organization for Research and Treatment of Cancer/Mycosis Study Group; HIV, human immunodeficiency virus; ICU, intensive care unit.

Prescribing Information

Click here for CRESEMBA® (isavuconazole) and Vfend (voriconazole) prescribing information 

References:

Lin SJ et al. Clin Infect Dis 2001;32(3):358–366.Garcia-Vidal C et al. PLoS One 2015;10(3):e0120370.Roden MM et al. Clin Infect Dis 2005;41(5):634–653.Skiada A et al. Clin Microbiol Infect 2011;17(12):1859–1867.Donnelley JP et al. Clin Infect Dis 2020;71(6);1367–1376.Bassetti M et al. Infect Dis Ther 2018;7(1):17–27.Bongomin F et al. J Fungi (Basel) 2017;3(4).Baddley JW et al. BMC Infect Dis 2013;13:29.Taccone FS et al. Crit Care 2015;19:7.Bassetti M and Bouza E. J Antimicrob Chemother 2017;72(Suppl 1):i39–i47.Bassetti M et al. IDCases 2018;12:7–9.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 August 2023Schauwvlieghe AFAD, et al. Lancet Respir Med 2018;6(10):782–792.Wauters J et al. Intensive Care Med 2012;38(11):1761–1768.

Feys S et al. Intensive Care Med 2021;47(8):819–834.

Gustot T et al. J Hepatol 2014;60(2):267–274.Contou D et al. Ann Intensive Care 2016;6(1):52.Levesque E et al. Ann Intensive Care 2019;9(1):31.Delsuc C et al. Crit Care 2015;19:421.Natesan SK and Chandrasekar PH. Infect Drug Resist 2016;9:291–300.Perfect JR. Nat Rev Drug Discov 2017;16(9):603–616.Binder U and Lass-Florl C. Mediterr J Hematol Infect Dis 2011;3(1):e20110016.Low CY and Rotstein C. F1000 Med Rep 2011;3:14.Trof RJ et al. Intensive Care Med 2007;33:1694–1703.do Monte Junior ES, et al. Clin Endosc 2020;53(6):746–749.Sen M et al. Indian J Ophthalmol 2021;69(2):244–252.Bassetti M et al. Clin Infect Dis 2021;72(Suppl 2):S121–S127.De Pauw B et al. Clin Infect Dis 2008;46(12):1813–1821.Blot SI et al. AM J Respir Crit Care Med 2012;186(1):56–64.
PP-CRB-GBR-2041. August 2023.
ICU Download this guide to support your diagnosis and treatment of patients with invasive aspergillosis in the ICU Download Loading

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