What types of Candida infections should be included when evaluating breakthrough infections during posaconazole prophylaxis? Antimicrob. Agents Chemother

In the November issue of Antimicrobial Agents and Chemother-apy, Dolton et al. published findings from a retrospective mul-ticenter study of posaconazole therapeutic drug monitoring (1). They found that among 72 patients taking posaconazole for pro-phylaxis against invasive fungal infections, 12 (17%) patients de-veloped breakthrough fungal infection. Median posaconazole concentrations in patients with a breakthrough fungal infection were significantly lower than in patients that did not develop fun-gal infection. Those authors concluded that low posaconazole concentrations are associatedwith breakthrough fungal infections and propose monitoring posaconazole concentrations to ensure optimal systemic exposure. However, we think that the criteria used for inclusion of patients have to be further discussed. The lack of a standard set of definitions for fungal infections used to be a major obstacle in clinical research, making it difficult to compare different clinical trials. As a result, defining criteria were published in 2002 by the European Organization for Re