{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T20:05:21Z","timestamp":1778097921023,"version":"3.51.4"},"reference-count":36,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T00:00:00Z","timestamp":1694476800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The broad\u2010spectrum antifungal isavuconazole is administered to treat invasive aspergillosis and mucormycosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Isavuconazole plasma concentrations in critically ill ICU patients with or without COVID\u201019 and invasive fungal infection were determined, and factors for sub\u2010therapeutic drug levels (&lt;1\u2009\u03bcg\/mL) were evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>Isavuconazole plasma levels were measured as part of therapeutic drug monitoring (TDM) in ICUs of a tertiary hospital. Concentrations determined 20\u201328\u2009h after previous dosing were defined as trough (C<jats:sub>min<\/jats:sub>) levels. A total of 160 C<jats:sub>min<\/jats:sub> levels from 62 patients with invasive fungal infections were analysed, 30 of which suffering from COVID\u201019. Patient characteristics included into univariable and multivariable analyses were gender, age, COVID\u201019 status, body mass index (BMI), sepsis\u2010related organ failure (SOFA) score, renal replacement therapy (RRT) and extracorporeal membrane oxygenation (ECMO) requirement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean C<jats:sub>min<\/jats:sub> of isavuconazole in all patients was 1.64\u2009\u03bcg\/mL (interquartile range 0.83\u20132.24\u2009\u03bcg\/mL, total range 0.24\u20135.67\u2009\u03bcg\/mL). In total, 34.4% of the C<jats:sub>min<\/jats:sub> values (corresponding to 46.8% of patients) were below a threshold concentration of 1\u2009\u03bcg\/mL. Drug concentrations between patients with or without COVID\u201019 did not differ (<jats:italic>p<\/jats:italic>\u2009=\u2009.43). In contrast, levels were significantly lower in patients with female sex (<jats:italic>p<\/jats:italic>\u2009=\u2009.0007), age\u2009\u2264\u200965\u2009years (<jats:italic>p<\/jats:italic>\u2009=\u2009.002), BMI\u2009&gt;\u200925 (<jats:italic>p<\/jats:italic>\u2009=\u2009.006), SOFA score\u2009&gt;\u200912 (<jats:italic>p<\/jats:italic>\u2009=\u2009.026), RRT (<jats:italic>p<\/jats:italic>\u2009=\u2009.017) and ECMO requirement (<jats:italic>p<\/jats:italic>\u2009=\u2009.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Isavuconazole plasma levels can be negatively affected by patients' risk factors, supportive renal replacement and ECMO therapy. Future prospective studies analysing the relevance of isavuconazole drug levels in ICU patient outcome are urgently needed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/myc.13653","type":"journal-article","created":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T04:23:06Z","timestamp":1694578986000},"page":"1071-1078","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Clinical and demographic factors affecting trough levels of isavuconazole in critically ill patients with or without COVID\u201019"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0654-6381","authenticated-orcid":false,"given":"Ralph","family":"Bertram","sequence":"first","affiliation":[{"name":"Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum N\u00fcrnberg Paracelsus Medical University  Nuremberg 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studies Paracelsus Medical University  Salzburg Austria"},{"name":"Department of Ophthalmology and Optometry Paracelsus Medical University  Salzburg Austria"},{"name":"Research Program Experimental Ophthalmology and Glaucoma Research Paracelsus Medical University  Salzburg Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6381-8991","authenticated-orcid":false,"given":"Martina","family":"Kinzig","sequence":"additional","affiliation":[{"name":"Institute for Biomedical and Pharmaceutical Research  Nuremberg\u2010Heroldsberg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Golo\u2010Sung","family":"Haarmeyer","sequence":"additional","affiliation":[{"name":"Department for Respiratory Medicine, Klinikum N\u00fcrnberg Paracelsus Medical University  Nuremberg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Baumg\u00e4rtel","sequence":"additional","affiliation":[{"name":"Department for Respiratory Medicine, Klinikum N\u00fcrnberg Paracelsus Medical University  Nuremberg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arnim","family":"Geise","sequence":"additional","affiliation":[{"name":"Department for Respiratory Medicine, Klinikum N\u00fcrnberg Paracelsus Medical University  Nuremberg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorothea","family":"Muschner","sequence":"additional","affiliation":[{"name":"Department for Respiratory Medicine, Klinikum N\u00fcrnberg Paracelsus Medical University  Nuremberg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens","family":"Nentwich","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Intensive Care Medicine, Klinikum N\u00fcrnberg Paracelsus Medical 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