Tailored Treatment of Invasive Fungal Infections

Abstract

The need to tailor antifungal treatment to local epidemiology and individual patient risk was a key theme of the 3rd Trends in Medical Mycology (TIMM-3) congress in Turin, Italy, 28–31 October 2007. Organized jointly by the European Confederation of Medical Mycology (ECMM) and the Infectious Diseases Group of the European Organisation for Research and Treatment of Cancer (EORTC), the TIMM-3 program reflected the importance of earlier intervention to reduce the current significant mortality associated with fungal infection in immunocompromised patients. The range of people at risk of invasive fungal infection (IFI) is expanding with the wider use of immunosuppressive agents in the treatment of cancer, rheumatoid arthritis and inflammatory bowel disorders, the growing number of patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) and the everincreasing population of individuals infected with HIV. Recent revisions of the EORTC/Bacteriology and Mycology Study Group (BAMSG) definitions of IFI, discussed at TIMM-3, have clarified the criteria for diagnosis of ‘proven’, ‘probable’ and ‘possible’ infection, and our knowledge of the epidemiology of infection and the factors which put some patients at additional risk is increasing. However, the limited availability and/or validation of diagnostic tests for infection prior to the onset of clinical symptoms means that there is continuing debate over the relative role of prophylactic, empiric, pre-emptive and specific approaches to treatment.