The Nature of Breakthrough Invasive Fungal Infections in Patients Receiving Prophylactic Voriconazole or Posaconazole

Voriconazole and posaconazole are commonly given to prevent invasive fungal infections (IFI) among hosts with underlying immunosuppression, but breakthrough invasive fungal infections (bIFI) occur in 2%–5%. In the absence of controlled trials, and a general scarcity of data, researchers identified 300 published studies describing 1076 patients with high-risk hematologic disorders who received antifungal prophylaxis with posaconazole or voriconazole and who developed bIFI.

Among the fungi associated with bIFI, molds comprised 77% (Aspergillus species, 40%; Mucorales, 20%; Fusarium and other molds, 17%), while yeasts (mostly non-albicans Candida species) encompassed 23%. bIFI due to Mucorales were more common in patients receiving voriconazole…