Breakthrough invasive fungal disease in patients receiving posaconazole primary prophylaxis: a 4-year study

AbstractPosaconazole (PSC) is currently recommended as primary prophylaxis in neutropenic patients with acute myeloid leukaemia (AML) and in allogenic haematopoietic stem cell transplantation (AHSCT) recipients with graft-versus-host disease (GVHD). Studies focusing on breakthrough invasive fungal disease (IFD) upon PSC prophylaxis show disparate results. In order to evaluate the incidence of IFD in patients on PSC prophylaxis and identify IFD risk factors, we carried out a retrospective study of all consecutive patients on PP from January 2007 to December 2010 in our hospital. Breakthrough IFDs were identified from the database of the central pharmacy and the French administrative database (PMSI), registering final medical diagnoses of hospitalized patients. Medical data were reviewed to study proven or probable IFD, according to EORTC/MSG definition. PSC plasma concentrations (PPC) were also retrieved. Poisson models were used for statistical analysis. Two hundred and seventy-nine patients received PSC prophylaxis for a median duration of 1.4 months (range 0.2–17.9). Proven (n = 6) or probable (n = 3) IFDs were diagnosed in nine cases (3.2%). IFD incidence rate per 100 person-month was 1.65 (95% CI, 0.79–2.97). IFDs were candidaemia (Candida glabrata, n = 2), pulmonary invasive aspergillosis (n = 3), disseminated fusariosis (n = 2) and pulmonary mucormycosis (n = 2). Seven deaths were reported, directly related to IFD in three patients (33.3%). First dosage of PPC under 0.3 mg/L was the single significant risk factor for IFD (RR, 7.77; 95% CI, 1.30–46.5; p 0.025). Breakthrough IFD in patients receiving PSC prophylaxis is rare but associated with a poor outcome. Low PSC plasma concentrations are associated with an increased risk of IFD

ISGRI: the INTEGRAL Soft Gamma-Ray Imager

For the first time in the history of high energy astronomy, a large CdTe gamma-ray camera is operating in space. ISGRI is the low-energy camera of the IBIS telescope on board the INTEGRAL satellite. This paper details its design and its in-flight behavior and performances. Having a sensitive area of 2621 cm$^2$ with a spatial resolution of 4.6 mm, a low threshold around 12 keV and an energy resolution of $\sim$ 8% at 60 keV, ISGRI shows absolutely no signs of degradation after 9 months in orbit. All aspects of its in-flight behavior and scientific performance are fully nominal, and in particular the observed background level confirms the expected sensitivity of 1 milliCrab for a 10$^6$s observation.Comment: INTEGRAL A&A special issu