Comparative activity of posaconazole and systemic azole agents against clinical isolates of filamentous fungi from a global surveillance programme.

OBJECTIVES

The activity of mould-active azoles was evaluated against 397 filamentous fungi causing invasive mould infections (IMI) worldwide. In addition, a tentative posaconazole epidemiological cut-off value (ECV) against was investigated.

METHODS

Isolates were susceptibility tested by the CLSI reference broth microdilution methods. Species identification was confirmed by MALDI-TOF and/or sequencing analysis.

RESULTS

spp. (81.9%) remained the most common organism causing IMI worldwide; approximately two-thirds of spp. recovered were . In general, more than 90% of 220 isolates were wild type (WT) to all mould-active azoles, except itraconazole (84.5% WT). The voriconazole non-susceptible (NS) rate was 7.7% overall and was higher in Europe (12.9%) than in the other regions (0%-5.8%). Posaconazole (MIC/MIC, 0.25/0.5 mg/L) showed similar or slightly higher activity than voriconazole (MIC/MIC, 0.5/0.5 mg/L) and isavuconazole (MIC/MIC, 0.5/1 mg/L) against . The mould-active azoles displayed similar activity against non- (WT rates >93%), but differences were observed among the main species/sections. Posaconazole, voriconazole, and isavuconazole inhibited at their respective ECVs 100%, 97.0%, and 100% of section ; 100%, 100%, and 93.8% of section ; and 97.3%, 100%, and 100% of section isolates. Posaconazole displayed potency greater than or equal to the other azoles against the Mucorales group and spp.

CONCLUSIONS

Posaconazole and other mould-active azoles showed good activity against spp. causing IMI, but clinicians should be aware of regional rates of voriconazole-NS .