Journal of the Pediatric Infectious Diseases Society · 2026
Activity of Isavuconazole and Comparator Agents Against Pediatric Isolates From Invasive Fungal Infections.
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Winkler Marisa L, Rhomberg Paul, Fedler Kelley, Edeker Samuel, Klauer Abby L, Castanheira Mariana
Аннотация
BACKGROUND: Invasive fungal infections (IFIs) are a rising problem among pediatric patients. Antifungal agents have data supporting treatment in pediatric patients of varying ages and infection types but in vitro susceptibility data for large collections of pediatric isolates are lacking, which limits empiric treatment. We describe in vitro antifungal susceptibility testing of 900 contemporary yeast and mold isolates collected from IFIs in patients ≤ 17 years of age as a part of the SENTRY Antifungal Surveillance Program.
METHODS: A total of 900 isolates (743 yeasts and 157 molds) were collected from 28 countries between 2017 and 2024. Antifungal susceptibility testing was performed by broth microdilution according to Clinical and Laboratory and Standards Institute (CLSI) methodology.
RESULTS: A total of 33.4% of isolates were from patients ≤ 1 year old, 22.1% from patients aged 2-5 years old, 24.4% from patients aged 6-12 years old, and 20.0% from patients aged 13-17 years old. In total, 63.0% of yeasts were recovered from patients ≤ 5 years old; 79.6% of molds were from patients ≥ 6 years old. Most yeast isolates (72.5%) were from bloodstream infections; most mold isolates (61.8%) were from the respiratory tract. By CLSI breakpoints, 88.5% and 87.5% of Aspergillus fumigatus isolates were susceptible to voriconazole and isavuconazole, respectively. Against Mucorales, the isavuconazole minimum inhibitory concentration (MIC)50 value was 4 mg/L, whereas the MIC50 values for voriconazole and posaconazole were > 8 mg/L. All agents had low MICs against most yeasts collected and there were few resistant or non-wildtype yeasts.
CONCLUSIONS: Broth microdilution among a diverse collection of isolates obtained from IFIs among pediatric patients showed low rates of resistance to echinocandins or azoles. Across species, the lowest MICs were observed for voriconazole and isavuconazole in yeasts. All triazoles were highly active against Aspergillus spp. Against non-Aspergillus molds, isavuconazole, posaconazole, and amphotericin B were the most active agents. These data can guide the antifungal treatment of IFIs in pediatric patients when susceptibility testing is unavailable.
METHODS: A total of 900 isolates (743 yeasts and 157 molds) were collected from 28 countries between 2017 and 2024. Antifungal susceptibility testing was performed by broth microdilution according to Clinical and Laboratory and Standards Institute (CLSI) methodology.
RESULTS: A total of 33.4% of isolates were from patients ≤ 1 year old, 22.1% from patients aged 2-5 years old, 24.4% from patients aged 6-12 years old, and 20.0% from patients aged 13-17 years old. In total, 63.0% of yeasts were recovered from patients ≤ 5 years old; 79.6% of molds were from patients ≥ 6 years old. Most yeast isolates (72.5%) were from bloodstream infections; most mold isolates (61.8%) were from the respiratory tract. By CLSI breakpoints, 88.5% and 87.5% of Aspergillus fumigatus isolates were susceptible to voriconazole and isavuconazole, respectively. Against Mucorales, the isavuconazole minimum inhibitory concentration (MIC)50 value was 4 mg/L, whereas the MIC50 values for voriconazole and posaconazole were > 8 mg/L. All agents had low MICs against most yeasts collected and there were few resistant or non-wildtype yeasts.
CONCLUSIONS: Broth microdilution among a diverse collection of isolates obtained from IFIs among pediatric patients showed low rates of resistance to echinocandins or azoles. Across species, the lowest MICs were observed for voriconazole and isavuconazole in yeasts. All triazoles were highly active against Aspergillus spp. Against non-Aspergillus molds, isavuconazole, posaconazole, and amphotericin B were the most active agents. These data can guide the antifungal treatment of IFIs in pediatric patients when susceptibility testing is unavailable.