Abstract
Background
Neutropenic patients with persistent fever despite antibiotic therapy are managed with empirical
or pre-emptive antifungal therapy. The aim of the present study was to evaluate the current
clinical use and efficacy of these two approaches in patients with high risk hematologic conditions.
Design and Methods
An electronic medical record system, the “Hema e-Chart”, was designed and implemented to
collect information prospectively on infectious complications, particularly on invasive fungal
diseases, in patients with hematologic malignancies treated with chemotherapy and/or autologous
or allogenic hemopoietic stem cell transplantation. The patients were enrolled from
Hematology units distributed widely across Italy.
Results
Three hundred and ninety-seven adults with hematologic malignancies treated with
chemotherapy with persistent fever and suspected invasive fungal disease were evaluable for
the study (190 treated had been treated with empirical antifungal therapy and 207 with preemptive
antifungal therapy). There was a significantly lower incidence of proven/probable
invasive fungal diseases in patients treated with empirical antifungal therapy (n=14, 7.4%) than
in patients treated with pre-emptive therapy (n=49, 23.7%) (P<0.001). The rate of deaths attributable
to invasive fungal diseases was significantly lower in subjects treated with empirical
antifungal therapy (1 case; 7.1%) than in subjects treated with pre-emptive therapy (11 cases;
22.5%) (P=0.002).
Conclusions
These data indicate that empirical antifungal treatment decreased the incidence of invasive fungal
disease and of attributable mortality with respect to a pre-emptive antifungal approach in
neutropenic febrile patients with hematologic malignancies
Lingua originale | English |
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pagine (da-a) | 1366-1370 |
Numero di pagine | 5 |
Rivista | Haematologica |
Volume | 96 |
DOI | |
Stato di pubblicazione | Pubblicato - 2011 |
Keywords
- hematological malignancies