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Objectives To analyse the susceptibility pattern of a collection of Alternaria spp. clinical isolates. Methods The antifungal susceptibilities of 35 isolates identified by means of sequencing the internal transcribed spacer region of rDNA were analysed by European Committee on Antimicrobial Susceptibility Testing (EUCAST) methodology. Results and conclusions No clear differences among the activity of antifungals against Alternaria alternata and Alternaria infectoria were detected, except for echinocandins. [ABSTRACT FROM PUBLISHER]

The European Confederation of Medical Mycology (ECMM) collected data on epidemiology, risk factors, treatment, and outcomes of patients with culture-proven candidaemia across Europe to assess how adherence to guideline recommendations is associated with outcomes. In this observational cohort study, 64 participating hospitals located in 20 European countries, with the number of eligible hospitals per country determined by population size, included the first ten consecutive adults with culture-proven candidaemia after July 1, 2018, and entered data into the ECMM Candida Registry (FungiScope Candi Reg). We assessed ECMM Quality of Clinical Candidaemia Management (EQUAL Candida) scores reflecting adherence to recommendations of the European Society of Clinical Microbiology and Infectious Diseases and the Infectious Diseases Society of America guidelines. 632 patients with candidaemia were included from 64 institutions. Overall 90-day mortality was 43% (265/617), and increasing age, intensive care unit admission, point increases in the Charlson comorbidity index score, and Candida tropicalis as causative pathogen were independent baseline predictors of mortality in Cox regression analysis. EQUAL Candida score remained an independent predictor of mortality in the multivariable Cox regression analyses after adjusting for the baseline predictors, even after restricting the analysis to patients who survived for more than 7 days after diagnosis (adjusted hazard ratio 1·08 [95% CI 1·04–1·11; p<0·0001] in patients with a central venous catheter and 1·09 [1·05–1·13; p<0·0001] in those without one, per one score point decrease). Median duration of hospital stay was 15 days (IQR 4–30) after diagnosis of candidaemia and was extended specifically for completion of parenteral therapy in 100 (16%) of 621 patients. Initial echinocandin treatment was associated with lower overall mortality and longer duration of hospital stay among survivors than treatment with other antifungals. Although overall mortality in patients with candidaemia was high, our study indicates that adherence to clinical guideline recommendations, reflected by higher EQUAL Candida scores, might increase survival. New antifungals, with similar activity as current echinocandins but with longer half-lives or oral bioavailability, are needed to reduce duration of hospital stay. Scynexis. [ABSTRACT FROM AUTHOR]

Background: Cerebral aspergillosis (CA) is associated with high mortality. According to the European Conference on Infections in Leukemia and the European Society of Clinical Microbiology and Infectious Diseases guidelines, the recommended first-line treatment for all forms of aspergillosis is voriconazole or isavuconazole. However, little is known about the efficacy and safety of isavuconazole in CA., Methods: We conducted a European multicenter retrospective study of patients treated with isavuconazole for proven or probable CA between 2014 and 2022 and compared the outcomes with those of weighted control groups from the previously published French national cohort of CA, the Cerebral Aspergillosis Lesional Study (CEREALS)., Results: Forty patients from 10 countries were included. The main underlying conditions were hematological malignancies (53%) and solid-organ transplantation (20%). Isavuconazole was administered as a first-line treatment to 10 patients, primarily in combination therapy, resulting in control of CA in 70% of these cases. Thirty patients received isavuconazole after a median of 65 days on another therapy, mostly because of side effects (50%) or therapeutic failure (23%) of the previous treatment. Predominantly given as monotherapy, it achieved control of CA in 73% of the patients. Seventeen patients (43%) underwent neurosurgery. When measured, isavuconazole levels were low in cerebrospinal fluid but adequate in serum and brain tissue. Isavuconazole toxicity led to treatment interruption in 7.5% of the patients. Twelve-week mortality was 18%. Comparison with the CEREALS cohort showed comparable survival in patients receiving isavuconazole or voriconazole as a first-line treatment., Conclusions: Isavuconazole appears to be a well-tolerated treatment. Mortality of CA treated with isavuconazole is similar to that reported with voriconazole., Competing Interests: Potential conflicts of interest. A. C.: honoraria from Novartis, Janssen, Pfizer, Gilead, Celgene, Incyte, AbbVie, Astellas. A. A.-I.: honoraria for educational talks on behalf of Gilead, Pfizer, Mundipharma, and MSD, outside the submitted work. H. H.: honoraria from Gilead, Sandoz, and Sanofi. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Access to the appropriate tools is crucial for early diagnosis and clinical management of invasive fungal infections. This Review aims to describe the invasive fungal infection diagnostic capacity of Europe to better understand the status and the most pressing aspects that need improvement. To our knowledge, this is the first time that the mycological diagnostic capability and access to antifungal treatments of institutions has been evaluated at a pan-European level. Between Nov 1, 2021, and Jan 31, 2022, 388 institutions in Europe self-assessed their invasive fungal infection management capability. Of the 388 participating institutions from 45 countries, 383 (99%) had access to cultures, 375 (97%) to microscopy, 363 (94%) to antigen-detection assays, 329 (85%) to molecular tests (mostly PCR), and 324 (84%) to antibody tests for diagnosis and management. With the exception of microscopy, there were considerable differences in access to techniques among countries according to their gross domestic product. At least one triazole was available in 363 (94%) of the institutions, one echinocandin in 346 (89%), and liposomal amphotericin B in 301 (78%), with country gross domestic product-based differences. Differences were also observed in the access to therapeutic drug monitoring. Although Europe is well prepared to manage invasive fungal infections, some institutions do not have access to certain diagnostic tools and antifungal drugs, despite most being considered essential by WHO. These limitations need to be overcome to ensure that all patients receive the best diagnostic and therapeutic management., Competing Interests: Declaration of interests JS-G received payments or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Gilead and Pfizer, outside of the submitted work. MH received grants or contracts from Gilead, Pfizer, Astellas, Euroimmune, MSD, Pulmocide, Scynexis, and F2G, outside of the submitted work. J-PG received grants or contracts from Pfizer, and consulting fees from Gilead and Pfizer, outside of the submitted work. AA-I received payments or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Gilead and Pfizer; received support for attending meetings and travel from Gilead; participated on a data safety monitoring board or advisory board for JPI-AMR; and had a leadership or fiduciary role in board, society, committee or advocacy groups that were either paid or unpaid, from WHO, European Society of Clinical Microbiology and Infectious Diseases, Fungal Infection Study Group, and Global Action For Fungal Infections, outside of the submitted work. KL received grants or contracts from Thermo Fisher Scientific and TECOmedical; consulting fees from Gilead, MSD, and MRM Health; and payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Pfizer, Gilead, and FUJIFILM Wako, outside of the submitted work. SAA reports grants or contracts from Cidara; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Gilead; and support for attending meetings and travel from Astellas, outside of the submitted work. VÖ received grants or contracts from International Health Management Associates and Sentry, outside of the submitted work. OAC received grants or contracts from Amplyx, Basilea, Bundesministerium für Bildung und Forschung, Cidara, Deutsches Zentrum für Infektionsforschung, EU Directorate-General for Research and Innovation (grant: 101037867), F2G, Gilead, Matinas, MedPace, MSD, Mundipharma, Octapharma, Pfizer, and Scynexis; consulting fees from AbbVie, Amplyx, Biocon, Biosys, Cidara, Da Volterra, Gilead, Matinas, MedPace, Menarini, Molecular Partners, Mycoses Study Group Education and Research Consortium (MSG-ERC), Noxxon, Octapharma, Pardes, PSI, Scynexis, and Seres; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Abbott, Al-Jazeera Pharmaceuticals, Astellas, Grupo Biotoscana/United Medical/Knight, Hikma, MedScape, MedUpdate, Merck-MSD, Mylan, and Pfizer; payment for expert testimony from Cidara; patents planned, issued, or pending from the German Patent and Trademark Office; participation on a data safety monitoring board or advisory board for Actelion, Allecra, Cidara, Entasis, IQVIA, Janssen, MedPace, Paratek, PSI, Pulmocide, and Shionogi; and other financial or non-financial interests from Deutsche Gesellschaft für Hämatologie und Medizinische Onkologie, Deutsche Gesellschaft für Information und Wissen, European Confederation of Medical Mycology, International Society for Human and Animal Mycology, MSG-ERC, and Wiley, outside of the submitted work. ES and AV declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

The global burden of the endemic mycoses (blastomycosis, coccidioidomycosis, emergomycosis, histoplasmosis, paracoccidioidomycosis, sporotrichosis, and talaromycosis) continues to rise yearly and these infectious diseases remain a leading cause of patient morbidity and mortality worldwide. Management of the associated pathogens requires a thorough understanding of the epidemiology, risk factors, diagnostic methods and performance characteristics in different patient populations, and treatment options unique to each infection. Guidance on the management of these infections has the potential to improve prognosis. The recommendations outlined in this Review are part of the "One World, One Guideline" initiative of the European Confederation of Medical Mycology. Experts from 23 countries contributed to the development of these guidelines. The aim of this Review is to provide an up-to-date consensus and practical guidance in clinical decision making, by engaging physicians and scientists involved in various aspects of clinical management., Competing Interests: Declaration of Interests GRT received research funding from Amplyx Pharmaceuticals, Astellas, Basilea Pharmaceutica, Cidara Therapeutics, F2G, IMMY, Mayne Pharma, and Scynexis, and served as a consultant for Amplyx Pharmaceuticals, Astellas, Basilea Pharmaceutica, Cidara Therapeutics, F2G, IMMY, Mayne Pharma, Scynexis, and Pfizer. MJB is a founding partner and holds shares of Micología Molecular SL, she has received grant support from the Instituto de Salud Carlos III and has been paid for talks on behalf of United Medical LTDA. AA-I has received research grants to their institution from F2G and honoraria as a speaker from Gilead Sciences and Pfizer. DA-J holds share options in Pulmocide and has received grant support from Pulmocide, Astellas Pharma, Pfizer, and Gilead Sciences. He has received lecture honoraria from Astellas Pharma, Pfizer, Gilead Sciences, and AstraZeneca. JWB has served as a consultant for Pfizer. JFWC has received travel grants from Pfizer Corporation Hong Kong and Astellas Pharma Hong Kong, and was an invited speaker for Gilead Sciences Hong Kong and Luminex Corporation. OAC is funded by the German Federal Ministry of Education and Research, is funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany's Excellence Strategy (CECAD, EXC 2030—390661388), and has received research grants from Actelion, Amplyx Pharmaceuticals, Astellas Pharma, Basilea Pharmaceutica, Cidara Therapeutics, Da Volterra, F2G, Gilead Sciences, Janssen Pharmaceuticals, Medicines Company, MedPace, Melinta Therapeutics, Merck/MSD, Pfizer, and, Scynexis. OAC is also a consultant to Actelion, Allecra Therapeutics, Amplyx Pharmaceuticals, Astellas, Basilea Pharmaceutica, Biosys UK, Cidara Therapeutics, Da Volterra, Entasis, F2G, Gilead Sciences, Matinas BioPharma, MedPace, Menarini Ricerche, Roche Diagnostics, Merck/MSD, Nabriva Therapeutics, Octapharma, Paratek Pharmaceuticals, Pfizer, PSI, Rempex, Scynexis, Seres Therapeutics, Tetraphase, and Vical, and received lecture honoraria from Astellas, Basilea Pharmaceutica, Gilead Sciences, Grupo Biotoscana, Merck/MSD, and Pfizer. NK received honoraria from Astellas, Gilead Sciences, Merck/MSD, and Pfizer, and received grants from Merck/MSD and Pfizer. NK was a speaker for Astellas, Gilead Sciences, Merck/MSD, and Pfizer and an adviser for Gilead Sciences, Merck/MSD, and Pfizer. DCMK has sat on advisory boards for Becton Dickinson and Merck/MSD, and received financial and travel support unrelated to the current work from Merck/MSD. MHM has received research support and served as a consultant for Astellas and Scynexis. ISS has served as an adviser to Avir Pharma. AS has received grant funding from Astellas and has consulted for Scynexis, Minnetronix Medical, Mayne Pharma, and Viamet Pharmaceuticals. J-PG has received research grant support from Pfizer. FQ-T has received research grants from Astellas, Merck/MSD, and Pfizer, and also received payments for presentations and continued medical education from Merck/MSD, Pfizer, United Medical, and Teva Brazil. PEV reported grants from Gilead Sciences, Merck/MSD, Pfizer, F2G, and Thermo Fisher Scientific, and travel support from OLM Systems and IMMY, outside of the submitted work. ACP has received research grant support on behalf of Pfizer, Gilead Sciences, Merck/MSD, and IMMY. He has also given paid talks for Pfizer, United Medical, Gilead Sciences, Merck/MSD, Astellas, and IMMY, and participated on the medical board of Pfizer, United Medical, Gilead Sciences, and Merck/MSD. All other authors declare no competing interests., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The standardization of antifungal sensitivity tests represents a huge advance in the detection of antifungal drug resistance. Thus, the reference methods of the European Committee on Antibiotic Susceptibility Testing and the Clinical Laboratory Standards Institute have proven capable of detecting strains of yeasts and filamentous fungi with high minimum inhibitory concentrations (MIC) to antifungal agents. This standardization has enabled the genetic alterations responsible for the high MICs to be studied at the molecular level. Furthermore, these strains have been used in experimental models to obtain pharmacokinetic parameters that may allow us to predict clinical response. However, the correlation of the course of the infection in humans with the sensitivity or resistance of the strain is a controversial area with many unanswered questions. We analyze whether the MICs of human pathogenic fungi have clinical relevance, that is, if they affect the course of the infection.