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Antibiotic-induced modulation of the intestinal microbiota can lead to Clostridioides difficile infection (CDI), which is associated with considerable morbidity, mortality, and healthcare-costs globally. Therefore, identification of markers predictive of CDI could substantially contribute to guiding therapy and decreasing the infection burden. Here, we analyze the intestinal microbiota of hospitalized patients at increased CDI risk in a prospective, 90-day cohort-study before and after antibiotic treatment and at diarrhea onset. We show that patients developing CDI already exhibit significantly lower diversity before antibiotic treatment and a distinct microbiota enriched in Enterococcus and depleted of Ruminococcus, Blautia, Prevotella and Bifidobacterium compared to non-CDI patients. We find that antibiotic treatment-induced dysbiosis is class-specific with beta-lactams further increasing enterococcal abundance. Our findings, validated in an independent prospective patient cohort developing CDI, can be exploited to enrich for high-risk patients in prospective clinical trials, and to develop predictive microbiota-based diagnostics for management of patients at risk for CDI., Clostridioides difficile infection (CDI) is the most common cause of antibiotic-associated diarrhoea (AAD); however, markers predictive of CDI or AAD development are as yet lacking. Here, to identify markers predictive of CDI, the authors profile the intestinal microbiota of 945 hospitalised patients from 34 hospitals in 6 different European countries and show distinct microbiota enriched in Enterococcus and depleted of Ruminococcus, Blautia, Prevotella and Bifidobacterium compared to non-CDI patients.

Background First-line antifungal treatment for invasive mucormycosis (IM) consists of liposomal amphotericin B. Salvage treatment options are limited and often based on posaconazole oral suspension. With the approval of posaconazole new formulations, patients could benefit from improved pharmacokinetics, safety and tolerability. Objectives Our aim was to assess the effectiveness of posaconazole new formulations for IM treatment. Methods We performed a case-matched analysis with proven or probable IM patients from the FungiScope® Registry. First-line posaconazole new formulations (1st-POSnew) and first-line amphotericin B plus posaconazole new formulations (1st-AMB+POSnew) cases were matched with first-line amphotericin B-based (1st-AMB) treatment controls. Salvage posaconazole new formulations (SAL-POSnew) cases were matched with salvage posaconazole oral suspension (SAL-POSsusp) controls. Each case was matched with up to three controls (based on severity, haematological/oncological malignancy, surgery and/or renal dysfunction). Results Five patients receiving 1st-POSnew, 18 receiving 1st-AMB+POSnew and 22 receiving SAL-POSnew were identified. By day 42, a favourable response was reported for 80.0% (n = 4/5) of patients receiving 1st-POSnew, for 27.8% (n = 5/18) receiving 1st-AMB+POSnew and for 50.0% (n = 11/22) receiving SAL-POSnew. Day 42 all-cause mortality of patients receiving posaconazole new formulations was lower compared with controls [20.0% (n = 1/5) in 1st-POSnew versus 53.3% (n = 8/15) in 1st-AMB; 33.3% (n = 6/18) in 1st-AMB+POSnew versus 52.0% (n = 26/50) in 1st-AMB; and 0.0% (n = 0/22) in SAL-POSnew versus 4.4% (n = 2/45) in SAL-POSsusp]. Conclusions Posaconazole new formulations were effective in terms of treatment response and associated mortality of IM. While posaconazole new formulations may be an alternative for treatment of IM, the limited sample size of our study calls for a cautious interpretation of these observations.

Trial enrichment using gut microbiota derived biomarkers by high-risk individuals can improve the feasibility of randomized controlled trials for prevention of Clostridioides difficile infection (CDI). Here, we report in a prospective observational cohort study the incidence of CDI and assess potential clinical characteristics and biomarkers to predict CDI in 1,007 patients ≥ 50 years receiving newly initiated antibiotic treatment with penicillins plus a beta-lactamase inhibitor, 3rd/4th generation cephalosporins, carbapenems, fluoroquinolones or clindamycin from 34 European hospitals. The estimated 90-day cumulative incidences of a first CDI episode is 1.9% (95% CI 1.1-3.0). Carbapenem treatment (Hazard Ratio (95% CI): 5.3 (1.7-16.6)), toxigenic C. difficile rectal carriage (10.3 (3.2-33.1)), high intestinal abundance of Enterococcus spp. relative to Ruminococcus spp. (5.4 (2.1-18.7)), and low Shannon alpha diversity index as determined by 16 S rRNA gene profiling (9.7 (3.2-29.7)), but not normalized urinary 3-indoxyl sulfate levels, predicts an increased CDI risk., Here, the authors report the incidence of Clostridioides difficile infection (CDI) and assess potential clinical characteristics and biomarkers to predict CDI in 1,007 patients of 50 years and above receiving newly initiated antibiotic treatment.

IMPORTANCE Herpes zoster, a frequent complication following autologous hematopoietic stem cell transplantation (HSCT), is associated with significant morbidity. A nonlive adjuvanted recombinant zoster vaccine has been developed to prevent posttransplantation zoster. OBJECTIVE To assess the efficacy and adverse event profile of the recombinant zoster vaccine in immunocompromised autologous HSCT recipients. DESIGN, SETTING, AND PARTICIPANTS Phase 3, randomized, observer-blinded study conducted in 167 centers in 28 countries between July 13, 2012, and February 1, 2017, among 1846 patients aged 18 years or older who had undergone recent autologous HSCT. INTERVENTIONS Participants were randomized to receive 2 doses of either recombinant zoster vaccine (n=922) or placebo (n=924) administered into the deltoid muscle; the first dose was given 50 to 70 days after transplantation and the second dose 1 to 2 months thereafter. MAIN OUTCOMES AND MEASURES The primary end point was occurrence of confirmed herpes zoster cases. RESULTS Among 1846 autologous HSCT recipients (mean age, 55 years; 688 [37%] women) who received 1 vaccine or placebo dose, 1735 (94%) received a second dose and 1366 (74%) completed the study. During the 21-month median follow-up, at least 1 herpes zoster episode was confirmed in 49 vaccine and 135 placebo recipients (incidence, 30 and 94 per 1000 person-years, respectively), an incidence rate ratio (IRR) of 0.32 (95% CI, 0.22-0.44; P

EgeUn###, Importance: Herpes zoster, a frequent complication following autologous hematopoietic stem cell transplantation (HSCT), is associated with significant morbidity. A nonlive adjuvanted recombinant zoster vaccine has been developed to prevent posttransplantation zoster. Objective: To assess the efficacy and adverse event profile of the recombinant zoster vaccine in immunocompromised autologous HSCT recipients. Design, Setting, and Participants: Phase 3, randomized, observer-blinded study conducted in 167 centers in 28 countries between July 13, 2012, and February 1, 2017, among 1846 patients aged 18 years or older who had undergone recent autologous HSCT. Interventions: Participants were randomized to receive 2 doses of either recombinant zoster vaccine (n = 922) or placebo (n = 924) administered into the deltoid muscle; the first dose was given 50 to 70 days after transplantation and the second dose 1 to 2 months thereafter. Main Outcomes and Measures: The primary end point was occurrence of confirmed herpes zoster cases. Results: Among 1846 autologous HSCT recipients (mean age, 55 years; 688 [37%] women) who received 1 vaccine or placebo dose, 1735 (94%) received a second dose and 1366 (74%) completed the study. During the 21-month median follow-up, at least 1 herpes zoster episode was confirmed in 49 vaccine and 135 placebo recipients (incidence, 30 and 94 per 1000 person-years, respectively), an incidence rate ratio (IRR) of 0.32 (95% CI, 0.22-0.44; P, Cornell University University of Manchester Universitat de València University of Kansas Medical Center, KUMC University of Manchester College of Medicine, Korea University Chonnam National University, CNU North Carolina GlaxoSmithKline Foundation Università degli Studi del Piemonte Orientale, UPO Gilead Sciences Pfizer National Institute of Allergy and Infectious Diseases, NIAID Amgen Merck GlaxoSmithKline foundation, GSK National and Kapodistrian University of Athens Chung Hua University, CHU University of Melbourne Thomas Jefferson University, TJU National Center for Medical Rehabilitation Research, NCMRR Cancer Center, University of Colorado National Cancer Center Helsingin Yliopisto Hacettepe Üniversitesi Tufts Medical Center City, University of London, City Gachon University Chung Hua University, CHU Uniwersytet Jagiellonski Collegium Medicum Manchester Biomedical Research Centre, BRC China Medical University Hospital, CMUH Chonbuk National University Hospital Seoul National University Hospital, SNUH Universitair Medisch Centrum Utrecht, UMC Universiti Kebangsaan Malaysia University of Seoul, UOS University of Minnesota, UM Ankara Universitesi Cleveland Clinic Foundation, CCF City, University of London, City University of North Carolina at Chapel Hill, UNC-CH Kyungpook National University, KNU, Author Affiliations: GlaxoSmithKline, Wavre, Belgium (Bastidas, Campora, Lopez-Fauqued); Hospital Universitario 12 de Octubre, Madrid, Spain (de la Serna); GlaxoSmithKline, Rixensart, Belgium (El Idrissi); CureVac AG, Tübingen, Germany (Oostvogels); University Hospital of Montpellier, Montpellier, France (Quittet); Hospital Ramón y Cajal, Madrid, Spain (López-Jiménez); Ege University Medical School, Izmir, Turkey (Vural); Charles University Hospital, Prague, Czech Republic (Pohlreich); Rambam Health Care Campus, Haifa, Israel (Zuckerman); Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts (Issa); Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy (Gaidano); Chonnam National University Hwasun Hospital, Jellanamdo, Republic of Korea (J.-J. Lee); University of Kansas Cancer Center, Westwood (Abhyankar); Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, Spain (Solano); Centro Integral Oncológico Clara Campal (CIOCC), Universidad CEU San Pablo, Madrid, Spain (Perez de Oteyza); Weill Medical College of Cornell University, New York, New York (Satlin); Department of Hematology and Oncology, Charité University Medical Center, Berlin, Germany (Schwartz); Preventive Medicine and Epidemiology Department, University Hospital Vall d’Hebron, Barcelona, Spain (Campins); Haematology Department, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, England (Rocci); Faculty of Biology, Medicine and Health, School of Medical Science, Division of Cancer Sciences, University of Manchester, Manchester, England (Rocci); Hospital de Donostia, San Sebastián, Spain (Vallejo Llamas); Department of Internal Medicine, Seoul St Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea (D.-G. Lee); Hospital Ampang, Selangor, Malaysia (Tan); Royal Hobart Hospital, Hobart, Australia (Johnston); Department of Clinical Haematology, Austin Health, Heidelberg, Australia (Grigg); Fred Hutchinson Cancer Research Center, Seattle, Washington (Boeckh); Halozyme Therapeutics, San Diego, California (Heineman); University of Pennsylvania, Philadelphia (Stadtmauer); Duke University Medical Center, Durham, North Carolina (Sullivan). -- reported being employed by and holding stock options in GlaxoSmithKline (GSK). Dr El Idrissi reported being employed by and holding stock options in GSK. Dr Oostvogels reported being employed by GSK during conception and/or conduct of the study and being currently employed by CureVac AG; being an inventor on a patent owned by GSK relevant to recombinant zoster vaccine; and holding stock in GSK. Dr López-Jiménez reported receipt of grants from Hospital Ramon y Cajal. Dr Vural reported receipt of grants and personal fees from GSK. Dr Issa reported receipt of grants from GSK, Merck, and Astellas and personal fees from Akros Pharma. Dr Gaidano reported receipt of trial patient fees from GSK and personal fees from Abbvie, Roche, Gilead, Janssen, and Morphosys. Dr Perez de Oteyza reported receipt of grants from GSK, Pharmacyclics, Vivia-Biotech, Morphosys, and Helsinn; grants and personal fees from Roche, Janssen, Takeda, and Celgene; and personal fees from Servier and Gilead. Dr Satlin reported receipt of grants from GSK, Allergan, Merck, Biofire Diagnostics, and Biomerieux and consulting fees from Achaogen and Shionogi. Dr Schwartz reported receipt of grants from GSK and personal fees and nonfinancial support from Amgen, Basilea Pharmaceutica, Gilead, Jazz Pharmaceuticals, Merck Sharp & Dohme, and Pfizer. Dr Campins reported receipt of grants and personal fees from GSK; participation as an investigator in clinical trials from GSK and Novartis; and participation in expert meetings and symposiums organized by Pfizer, GSK, Sanofi-Pasteur, Merck Sharp & Dohme, and Novartis. Dr Rocci reported receipt of consultancy fees from Takeda and Sanofi and honoraria from Takeda, Celgene, Novartis, Amgen, and Janssen and advisory board membership for Novartis, Amgen, and Janssen. Dr Johnston reported receipt of personal fees from Roche, Janssen Cilag, Celgene, and Merck Sharp & Dohme. Dr Grigg reports advisory board membership for Novartis, Gilead, Roche, Merck Sharp & Dohme, Takeda, and Bristol-Myers Squibb. Dr Boeckh reported receipt of grants and personal fees from GSK, Merck, and Chimerix and personal fees from Clinigen. Dr Campora reported being an employee of GSK; owning shares in GSK; and receipt of personal fees from GSK. Dr Lopez-Fauqued reported being an employee of GSK. Dr Heineman reported being an employee of GSK during conception and/or conduct of the study; holding stock and stock options in GSK; being an inventor on a patent owned by GSK relevant to recombinant zoster vaccine; being a paid consultant for GSK. Dr Stadtmauer reported receipt of grants from GSK. Dr Sullivan reported receipt of grants and personal fees from GSK; personal fees from Kiadis Pharmaceutical and Roche Genentech; and a grant from the National Institute of Allergy and Infectious Diseases awarded to his university. No other disclosures were reported. -- (Hematology Department, National and Kapodistrian University of Athens, “Laikon” General Hospital, Athens, Greece), Veli-Jukka Anttila, MD, PhD (Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland), Mickael Aoun, MD (Microbiologie Infectious Diseases, Institut Jules Bordet, Bruxelles, Belgium), Ibrahim Barista, MD (Hacettepe University Medical Faculty, Ankara, Turkey), Leanne Berkahn, MB, ChB (Department of Heamatology, Auckland City Hospital, Grafton, New Zealand), Adrian J. C. Bloor, PhD, FRCP (Haematology and Transplant Unit, Christie NHS Foundation Trust, Manchester, England), Raewyn Broady, MB, ChB (Vancouver General Hospital, Vancouver, British Columbia, Canada), Peter Brossart, MD (Universitaetsklinikum Bonn, Bonn, Germany), Francis K. Buadi, MB, ChB (Mayo Clinic, Rochester, Minnesota), Claude-Eric Bulabois, MD (Service d’Hématologie, CHU de Grenoble–Hôpital Michallon, Grenoble, France), Guy Cantin, MD (CHU de Quebec–Hopital de l’Enfant-Jesus, Quebec City, Quebec, Canada), Claudia Cellini, MD (UO di Ematologia, Ospedale Santa Maria delle Croci, Ravenna, Italy), Pranatharthi Haran Chandrasekar, MD (Karmanos Cancer Institute, Detroit, Michigan), Thomas Chauncey, MD (Veterans Administration Puget Sound Health Care System, Seattle, Washington), Antonio Cuneo, MD (Unità Operativa di Ematologia, Azienda Ospedale Universitaria Arcispedale S. Anna, Venice, Italy), Sanjeet Singh Dadwal, MD (City of Hope National Medical Center, Duarte, California) , Michael Dickinson, MBBS(hons), DMedSci, FRACP, FRCPA (Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia), HyeonSeok Eom, MD, PhD (National Cancer Center, Kyunggi-do, Korea), Albert Esquirol Sanfeliu, MD (Hospital Santa Creu i Sant Pau, Barcelona, Spain), Christelle Ferra Coll, MD, PhD (Hospital Germans Trias i Pujol, Barcelona, Spain), Phyllis R. Flomenberg, MD (Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania), Ana Pilar González-Rodríguez, MD, PhD (Hospital Central de Asturias, Oviedo, Spain), David J. Gottlieb, MD (Department of Haematology, Westmead Hospital, Westmead, Australia), Sigal Grisariu, MD (Hadassah Medical Center, Jerusalem, Israel), Andreas Guenther, MD (Universitaetsklinikum Schleswig-Holstein, Kiel, Germany), Jonathan Gutman, MD (University of Colorado Cancer Center, Aurora), Uwe Hahn, MD (Department of Haematology and Oncology, Queen Elizabeth Hospital, Woodville, Australia), Werner J. Heinz, MD (Universitaetsklinikum Wuerzburg, Wuerzburg, Germany), Inmaculada Heras, MD, PhD (Hospital General Universitario J. M. Morales Meseguer, Murcia, Spain), Takashi Ikeda, MD, PhD (Shizuoka Cancer Center, Shizuoka, Japan), Isidro Jarque, MD, PhD (Hospital Universitario y Politécnico La Fe, Valencia, Spain), Meinolf Karthaus, MD (Staedtisches Krankenhaus Muenchen, Muenchen, Germany), Tessa Kerre, MD, PhD (Hematologie, UZ Gent, Gent, Belgium), Alexander Kiani, MD (Klinikum Bayreuth, Bayreuth, Germany), Andreas K. Klein, MD (Tufts Medical Center, Boston, Massachusetts), Grzegorz Kofla, MD (Charite, Berlin, Germany), Irina V. Kryuchkova, MD, PhD (Research Institute of Clinical Immunology, Novosibirsk, Russia), Ching-Yuan Kuo, MD (Chang Gung Memorial Hospital–Kaoshiung, Kaohsiung, Taiwan), John Kuruvilla, MD (Princess -- Margaret Hospital, Toronto, Ontario, Canada), Aleksey Kuvshinov (Russian Hematology and Transfusiology Research Center, St Petersburg, Russia), Jae-Yong Kwak, MD, PhD (Chonbuk National University Hospital, Jeonju, South Korea), Jae Hoon Lee, MD, PhD (Hematology, Gachon University Gil Hospital, Incheon, South Korea), Stéphane Lepretre, MD (Département d’Hématologie, Centre Henri Becquerel, Rouen, France), Albert Kwok-Wai Lie, MBBS (Division of Hematology/Oncology and Bone Marrow Transplantation, Department of Medicine, Queen Mary Hospital, Hong Kong, China), Alessandro Lucchesi, MD (Oncologia Medica, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy), Johan Maertens, MD, PhD (Hematologie, UZ Leuven–Campus Gasthuisberg, Leuven, Belgium), Erik W. A. Marijt, MD, PhD (Leids UMC, Leiden, Netherlands), Carmen Martínez Muñoz, MD (Hospital Clinic i Provincial, Barcelona, Spain), Mariagrazia Michieli, MD (UOS Dipartimento Terapia Cellulare-Chemioter Alte Dosi, Centro di Riferimento Oncologico IRCCS, Aviano, Italy), Samuel T. Milliken, MBBS (Department of Haematology, St Vincent’s Hospital, Darlinghurst, Australia), Noël Milpied, MD (Hématologie Clinique et Thérapie Cellulaire, CHU de Bordeaux–Hôpital du Haut Lévêque, Pessac, France), Jorge Monserrat Coll, MD (Hospital Virgen de la Arrixaca, Murcia, Spain), Sherif Beniameen Mossad, MD (Department of Infectious Diseases, Cleveland Clinic Foundation, Cleveland, Ohio), John Murphy, MB, ChB (Monklands Hospital, Airdrie, Scotland), María Belén Navarro Matilla, MD (Hospital Puerta de Hierro, Madrid, Spain), Jan Novak, MD, PhD (Oddeleni Klinicke Hematologie, Fakultni Nemocnice Kralovske Vinohrady, Prague, Czech Republic), Harold J. Olney, MD, CM (Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, Canada), Raquel Oña Navarrete, MD, PhD (M. D. Anderson, Madrid, Spain), María Jesús Pascual Cascón, MD (Hospital Carlos Haya, Málaga, Spain), Andy Peniket (Oxford University Biomedical Research Centre, Oxford, England), Ganeva Penka (CTH Sofia, Sofia, Bulgaria), Beata Piatkowska-Jakubas, DSc, MD (Department of Haematology, Jagiellonian University Medical College, Krakow, Poland), Marta Polo Zarzuela, MD (Hospital Clínico San Carlos, Madrid, Spain), Dimas Quiel, MD (Complejo Hospitalario Dr Arnulfo Arias Madrid, Panama City, Panama), Scott D. Rowley, MD, FACP (John Theuer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey), Waleed Sabry, MD, MSc, PhD (Saskatoon Cancer Centre, Saskatoon, Saskatchewan, Canada), Tommi Mikael Salmi, MD (Sisatautien Klinikka, Hematologian Yksikko os 015, Turun Yliopistollinen Keskussairaala, Turku, Finland), Dominik L. D. Selleslag, MD (Hematologie, AZ Sint-Jan Brugge– Oostende AV–Campus Sint-Jan, Brugge, Belgium), Thomas C. Shea, MD (Division of Hematology and Medical Oncology, University of North Carolina at Chapel Hill), Gerda Silling, MD (Universitaetsklinikum Muenster, Muenster, Germany), Ulla Marjatta Sinisalo, MD, PhD (Hematology Unit, Department of Internal Medicine, Tampere University Hospital, Tampere, Finland), Sang Kyun Sohn, MD, PhD (School of Medicine, Kyungpook National University, Daegu, South Korea), Peter Staib, MD, PhD (St Antonius Hospital, Eschweiler, Germany), Jeff Szer, MBBS (Haematology Department, Royal Melbourne Hospital, Parkville, Australia), Koen Theunissen, MD (Hematologie, Jessa Ziekenhuis–Campus Virga Jesse, Hasselt, Belgium), Pervin Topcuoglu, MD (Ankara University, Ankara, Turkey), Natalya G. Tyurina, PhD (Moscow Oncology Reserach Institute NA Herzen, Moscow, Russia), Mikhail Uvarov, MD, PhD (City Clinical Hospital No. 31, St Petersburg, Russia), Fadilah S. Abdul Wahid, PhD (Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia), Lucrecia Yáñez San Segundo, MD, PhD (Hospital Marqués de Valdecilla, Santander, Spain), Zeynep Arzu Yegin (Gazi University Medical Faculty, Ankara, Turkey), Su-Peng Yeh, MD (Department of Hematology, China Medical University Hospital, Taichung, Taiwan), Sze-Fai Yip, MD (Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong), Sung Soo Yoon, MD, PhD (Seoul National University Hospital, Seoul, South Korea), Jo-Anne H. Young, MD (University of Minnesota, Minneapolis), Pierre Zachée, MD, PhD (Hematologie-Oncologie, Ziekenhuisnetwerk Antwerpen, ZNA Stuivenberg and ZNA Middelheim, Antwerpen, Belgium), Francesco Zaja, MD (Clinica Ematologica, Azienda Ospedaliero Universitaria S. Maria Misericordia, Udine, Italy). Principal investigators and study sites are listed in eTable 9 and committees and GSK team members are listed in the eBox in Supplement 3. -- --

Annals of oncology 27(7), 1207-1225 (2016). doi:10.1093/annonc/mdw155, Published by Oxford Univ. Press, Oxford

Introduction: Reports on increasing identification of azole-resistant Aspergillus fumigatus in clinical and environmental isolates have raised concerns with respect to the frequency and clinical relevance of resistant Aspergillus spp. in hematological high-risk patient populations. Methods: In an[for full text, please go to the a.m. URL], Frühjahrstagung der Sektion Antimykotische Chemotherapie 2014

The Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO) here presents its updated recommendations for the treatment of documented fungal infections. Invasive fungal infections are a main cause of morbidity and mortality in cancer patients undergoing intensive chemotherapy regimens. In recent years, new antifungal agents have been licensed, and agents already approved have been studied in new indications. The choice of the most appropriate antifungal treatment depends on the fungal species suspected or identified, the patient’s risk factors (e.g., length and depth of neutropenia), and the expected side effects. This guideline reviews the clinical studies that served as a basis for the following recommendations. All recommendations including the levels of evidence are summarized in tables to give the reader rapid access to the information.