To investigate associations of the duration of voriconazole treatment and radiological response with relapse of invasive pulmonary aspergillosis (IPA) in immunocompromised patients, we explored the risk factors for IPA relapse after successful initial treatment. All patients with proven or probable IPA who had finished voriconazole treatment between 2005 and 2019 in a tertiary-care hospital were reviewed. IPA relapse was defined as re-diagnosis of proven or probable IPA at the same site within 1 year after treatment termination. Short course of voriconazole treatment was defined as a treatment less than 9 weeks, which is a median of the recommended minimum duration of therapy from the Infectious Disease Society of America. The radiological response was defined as a reduction in IPA burden by more than 50% on chest computed tomography. Of 87 patients who had completed voriconazole treatment, 14 (16.1%) experienced IPA relapse. Multivariable Cox regression identified that short voriconazole treatment duration (adjusted hazard ratio [aHR], 3.7; 95% confidence interval [CI], 1.1–12.3; P = 0.033) and radiological non-response (aHR, 4.6; 95% CI, 1.2–17.5; P = 0.026) were independently associated with relapse of IPA after adjusting for several clinical risk factors. Longer duration of therapy should be considered for those at higher risk of relapse.

为了研究伏立康唑治疗持续时间和放射学反应与免疫功能低下患者侵袭性肺曲霉病 (IPA) 复发的关联，我们探讨了初始治疗成功后 IPA 复发的危险因素。对 2005 年至 2019 年间在三级医院完成伏立康唑治疗的所有确诊或可能患有 IPA 的患者进行了审查。IPA 复发定义为治疗终止后 1 年内在同一部位再次诊断出已证实或可能的 IPA。短期伏立康唑治疗被定义为少于 9 周的治疗，这是美国传染病学会推荐的最短治疗持续时间的中位数。放射学反应被定义为胸部计算机断层扫描的 IPA 负担减少 50% 以上。在完成伏立康唑治疗的 87 名患者中，14 名 (16.1%) 出现 IPA 复发。多变量 Cox 回归确定伏立康唑治疗持续时间短（调整风险比 [aHR]，3.7；95% 置信区间 [CI]，1.1-12.3；P  = 0.033）和放射学无反应（aHR，4.6；95% CI，1.2-17.5；P  = 0.026）在调整了几个临床危险因素后与 IPA 的复发独立相关。对于复发风险较高的患者，应考虑延长治疗时间。