Pathogen distribution and, consequently, drug susceptibility seem to vary across different geographic regions. Furthermore, protection from invasive zygomycosis for patients on posaconazole prophylaxis is not absolute. Our findings indicate that the use of liposomal amphotericin B as first-line treatment for patients diagnosed with zygomycoses merits further investigation, preferably in the form of a clinical trial.

4736 Background Invasive zygomycosis accounts for a significant proportion of all invasive fungal diseases (IFD), but clinical data on the clinical course and treatment response is limited. Methods Fungiscope” - A Global Rare Fungal Infection Registry is a university-based case registry that collects data of patients with rare IFD, using a web-based electronic case form at www.fungiscope.net. Results Fourty-one patients with invasive zygomycosis were registered. Five were pediatric (12.2%), 28 (68.3%) male. Median age was 49 years (range 2-88). Most common underlying conditions were malignancies (n=26; 63.4%), diabetes mellitus (n=7; 17%) and solid organ transplant (n=4; 9.8%). Diagnosis was made by culture in 28 patients (68.3%), by histology in 26 patients (63.4%). Main sites of infection were lungs (n=24; 58.5%), soft tissues (n=8; 19.5%), rhino-sinu-orbital (n=8; 19.5%), brain (n=6; 14.6%). Disseminated infection of >1 non-contiguous sites was seen in 4 patients (9.8%). A favorable response was observed in 23 patients (56.1%). Overall survival was 51.2%. At diagnosis, ten patients (24.4%) were under continuous antifungal prophylaxis with itraconazole (n=1; 2.4%) or posaconazole (n=3; 7.3%). Empiric treatment was administered to 17 patients (41.4%). Survival was significantly improved in patients receiving active (n=7; 17.1%), as opposed to inactive empiric treatment (p=0.036). Initial targeted treatment with activity against zygomycetes was administered to 34 patients (82.9%). Liposomal amphotericin B was associated with improved response (p=0.012), and survival rates (p=0.004). Additional surgical treatment was performed in 21 patients (51.2%) and was not associated with improved response or survival. Conclusion Invasive zygomycosis is associated with low response rates to surgical and antifungal therapy. There was a marked amount of breakthrough infections under antifungal prophylaxis, including posaconazole. Only few patients received empiric treatment with activity against zygomycetes. Initial treatment with a polyene was associated with improved survival rates. Disclosures: Rueping: Essex/Schering-Plough: Speakers Bureau. Heinz:Schering-Plough/Essex: Consultancy, Research Funding, Speakers Bureau; MSD: Consultancy, Speakers Bureau; Gilead: Speakers Bureau; Pfizer: Speakers Bureau. Rickerts:Gilead: Research Funding; pfizer: Research Funding. Lass-Floerl:Gilead: Research Funding, Speakers Bureau; Pfizer: Consultancy, Research Funding, Speakers Bureau; MSD: Consultancy, Speakers Bureau. Herbrecht:Pfizer: Research Funding, Speakers Bureau; Gilead: Consultancy, Speakers Bureau; MSD: Consultancy, Speakers Bureau; Schering-Plough/Essex: Consultancy, Speakers Bureau. Silling:MSD: Consultancy, Research Funding; Pfizer: Research Funding; Astellas: Research Funding; Janssen-Cilag: Research Funding; Schering-Plough/Essex: Research Funding. Ullmann:Basilea: Consultancy; Aicuris: Consultancy; Pfizer: Consultancy, Speakers Bureau; Gilead: Consultancy, Speakers Bureau; MSD: Consultancy, Speakers Bureau; Schering-Plough/Essex: Consultancy, Speakers Bureau; Astellas: Consultancy, Speakers Bureau. Maertens:MSD: Consultancy, Research Funding; Pfizer: Research Funding; Astellas: Consultancy; Bio-Rad: Consultancy; Nektar: Consultancy; Schering-Plough/Essex: Consultancy; Zeneus/Cephalon: Consultancy; Viropharma: Consultancy. Maschmeyer:Pfizer: Consultancy, Research Funding, Speakers Bureau; MSD: Consultancy, Speakers Bureau; Gilead: Consultancy, Speakers Bureau. Vehreschild:Schering-Plough/Essex: Speakers Bureau; MSD: Speakers Bureau. Cornely:German Federal Ministry of Research and Education: Support - BMBF Grant 01KN0706; Astellas: Consultancy, Research Funding, Speakers Bureau; Basilea: Consultancy, Research Funding; Bayer: Research Funding; Genzyme: Research Funding; Gilead: Consultancy, Research Funding, Speakers Bureau; Pfizer: Consultancy, Research Funding; Merck/MSD: Consultancy, Research Funding, Speakers Bureau; Optimer: Research Funding; Schering-Plough/Essex: Consultancy, Research Funding, Speakers Bureau; Vicuron: Research Funding; F2G: Consultancy; Mölnlycke: Consultancy; Nektar: Consultancy; Zeneus: Consultancy; SpePharm: Speakers Bureau; United Medical: Speakers Bureau.

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