The performance of real-time PCR, galactomannan, and fungal culture in the diagnosis of invasive aspergillosis in ventilated patients with chronic obstructive pulmonary disease (COPD).

Emerging reports have associated chronic pulmonary obstructive disease (COPD) with invasive aspergillosis (IA), particularly in patients treated with mechanical ventilation and/or corticosteroids. This is a multicentre study in which COPD patients demonstrating a new lung infiltrate while being mechanically ventilated were prospectively evaluated for the presence of IA. From the 47 patients studied, Aspergillus fumigatus was recovered in culture in two patients (4.2%). While serum galactomannan (GM) was negative for 94% of patients, GM levels in respiratory samples were >0.5, >1.0 and >1.5 for 74.5, 40.5, and 21.3% of patients, respectively. PCR was positive for 10 patients in the study but did not differentiate Aspergillus colonization from infection. The combination of PCR and GM in respiratory samples may be an interesting alternative to diagnose IA in COPD patients.

Voriconazole therapeutic drug monitoring: focus on safety.

IMPORTANCE OF THE FIELD: Voriconazole has been widely used for the treatment of invasive fungal diseases, particularly invasive aspergillosis. Drug-drug interactions are, however, the main drawback associated with voriconazole use, since this drug suffers from extensive hepatic metabolism. AREAS COVERED IN THIS REVIEW: This article reviews the current literature on voriconazole therapeutic drug monitoring, with a special focus on drug safety. WHAT THE READER WILL GAIN: An update on voriconazole metabolism, drug interactions, toxicity and the relation of these with voriconazole drug concentrations. TAKE HOME MESSAGE: Therapy with voriconazole may be better guided by measuring voriconazole concentrations in the plasma.