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. 2025 Jun 25;11(7):480.
doi: 10.3390/jof11070480.

Current Challenges in the Treatment of Invasive Aspergillosis in Geriatric Patients

Sara Fueyo Álvarez  1   2 , Elena Valle Calonge  1   2   3 , Julieth Andrea Caballero Velasquez  1   2 , Alba Magaly Revelo Rueda  1   2 , Pablo Enrique Solla Suarez  1   2   3 , Eva María López Álvarez  1   2   3 , Mercedes Rodriguez Perez  2   3 , María Teresa Peláez García de la Rasilla  2   3
Affiliations

Current Challenges in the Treatment of Invasive Aspergillosis in Geriatric Patients

Sara Fueyo Álvarez et al. J Fungi (Basel). .

Abstract

Background: Invasive aspergillosis (IA) is a severe fungal infection increasingly affecting elderly patients with chronic respiratory diseases and prolonged corticosteroid use. Methods: We evaluated clinical, biochemical, and fungal biomarkers in 45 patients over 80 years diagnosed with IA and hospitalized in a Spanish Acute Geriatric Unit. Patients received either voriconazole or isavuconazole. Mortality rates and associated risk factors were analyzed. Results: Overall mortality was 35.61%. Significant mortality risk factors included leukocytosis (p = 0.0371), neutrophilia (p = 0.0144), and lymphopenia (p = 0.0274). Deceased patients had longer hospital stays (26.6 vs. 16.8 days; p = 0.00353). Voriconazole treatment was associated with higher 30-day mortality (61.5% vs. 19.2%; p = 0.0001) and a higher incidence of adverse effects (60% vs. 5%; p = 0.0003) compared to isavuconazole. Voriconazole also showed greater pharmacokinetic variability, with 76.9% of cases outside the therapeutic range. Conclusions: Voriconazole may not be optimal for IA treatment in patients over 80 years. Isavuconazole demonstrated a more favorable safety and efficacy profile. Personalized therapeutic strategies and a multidisciplinary approach are essential to improve clinical outcomes and quality of life in this vulnerable population.

Keywords: geriatrics; invasive aspergillosis; mortality.

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Conflict of interest statement

The authors declare no conflicts of interest or state.

Figures

Figure 1
Figure 1
Patients included and excluded from the study.
Figure 2
Figure 2
Adverse effects in patients according to treatment: Voriconazole vs. isavuconazole.
See this image and copyright information in PMC

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