{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T14:55:48Z","timestamp":1777560948096,"version":"3.51.4"},"reference-count":50,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,3,31]],"date-time":"2022-03-31T00:00:00Z","timestamp":1648684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/TOO5572\/1"],"award-info":[{"award-number":["MR\/TOO5572\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/R015600\/1"],"award-info":[{"award-number":["MR\/R015600\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/V037315\/1"],"award-info":[{"award-number":["MR\/V037315\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["219551\/Z\/19\/Z"],"award-info":[{"award-number":["219551\/Z\/19\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000292","name":"Cystic Fibrosis Trust","doi-asserted-by":"publisher","award":["SRC015"],"award-info":[{"award-number":["SRC015"]}],"id":[{"id":"10.13039\/501100000292","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Royal Brompton Hospital Charity Fellowship","award":["2019-008"],"award-info":[{"award-number":["2019-008"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Background: Instances of resistant fungal infection are rising in pulmonary disease, with limited therapeutic options. Therapeutic drug monitoring of azole antifungals has been necessary to ensure safety and efficacy but is considered unnecessary for the newest triazole isavuconazole. Aims: To characterise the prevalence of isavuconazole resistance and use in a tertiary respiratory centre. Methods: A retrospective observational analysis (2016\u20132021) of adult respiratory patients analysing fungal culture, therapeutic drug monitoring, and outcome post-isavuconazole therapy. Results: During the study period, isavuconazole susceptibility testing was performed on 26 Aspergillus spp. isolates. A total of 80.8% of A. fumigatus isolates had isavuconazole (MIC &gt; 1 mg\/L, and 73.0% &gt; 2 mg\/L) with a good correlation to voriconazole MIC (r = 0.7, p = 0.0002). A total of 54 patients underwent isavuconazole therapy during the study period (median duration 234 days (IQR: 24\u2013499)). A total of 67% of patients tolerated isavuconazole, despite prior azole toxicity in 61.8%, with increased age (rpb = 0.31; p = 0.021) and male sex (\u03c6c = 0.30; p = 0.027) being associated with toxicity. A total of 132 isavuconazole levels were performed with 94.8% &gt; 1 mg\/L and 72% &gt; 2 mg\/L. Dose change from manufacturer\u2019s recommendation was, however, required in 9.3% to achieve a concentration of &gt;2 mg\/L. Conclusion: We describe the use of isavuconazole as a salvage therapy in a chronic pulmonary fungal disease setting with a high prevalence of azole resistance. Therapeutic concentrations at standard dosing were high; however, results reinforce antifungal stewardship for optimization.<\/jats:p>","DOI":"10.3390\/jof8040362","type":"journal-article","created":{"date-parts":[[2022,3,31]],"date-time":"2022-03-31T21:34:29Z","timestamp":1648762469000},"page":"362","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Experience of Isavuconazole as a Salvage Therapy in Chronic Pulmonary Fungal Disease"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9146-2873","authenticated-orcid":false,"given":"Lisa","family":"Nwankwo","sequence":"first","affiliation":[{"name":"Pharmacy Department, Royal Brompton Hospital, Guy\u2019s and St. Thomas\u2019 NHS Foundation Trust, London SW3 6NP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Desmond","family":"Gilmartin","sequence":"additional","affiliation":[{"name":"Clinical Informatics, Royal Brompton and Harefield Hospital Foundation NHS Trust, Fulham, London SW3 6HP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheila","family":"Matharu","sequence":"additional","affiliation":[{"name":"Clinical Informatics, Royal Brompton and Harefield Hospital Foundation NHS Trust, Fulham, London SW3 6HP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3738-8833","authenticated-orcid":false,"given":"Ali","family":"Nuh","sequence":"additional","affiliation":[{"name":"Microbiology Department, Royal Brompton Hospital, Guy\u2019s and St. Thomas\u2019 NHS Foundation Trust, London SW3 6NP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jackie","family":"Donovan","sequence":"additional","affiliation":[{"name":"Department of Pathology, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1014-7343","authenticated-orcid":false,"given":"Darius","family":"Armstrong-James","sequence":"additional","affiliation":[{"name":"Microbiology Department, Royal Brompton Hospital, Guy\u2019s and St. Thomas\u2019 NHS Foundation Trust, London SW3 6NP, UK"},{"name":"MRC Centre for Molecular Bacteriology and Infection, Department of Infectious Diseases, Imperial College London, London SW7 2AZ, UK"},{"name":"Department of Respiratory Medicine, Royal Brompton Hospital, Guy\u2019s and St. Thomas\u2019 NHS Foundation Trust, London SW3 6NP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5257-520X","authenticated-orcid":false,"given":"Anand","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Royal Brompton Hospital, Guy\u2019s and St. Thomas\u2019 NHS Foundation Trust, London SW3 6NP, UK"},{"name":"MRC Centre of Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London W2 1PG, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jinf.2016.10.005","article-title":"Estimating the burden of invasive and serious fungal disease in the United Kingdom","volume":"74","author":"Pegorie","year":"2017","journal-title":"J. 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