Empirical vs pre-emptive broad-spectrum antifungal therapy for acute myelogenous leukaemia in the era of antimould prophylaxis
Copyright © 2023 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved..
INTRODUCTION: This study compared clinical outcomes in patients with acute myelogenous leukaemia (AML) who developed prolonged (≥4 days) febrile neutropenia (FN) and received either empirical or pre-emptive antimould prophylaxis in order to evaluate the need for routine empirical antifungal therapy.
METHODS: This retrospective study reviewed adult patients (aged ≥18 years) with AML who developed prolonged FN and received antimould prophylaxis during induction or re-induction chemotherapy at a single centre between September 2016 and December 2020. Patients were categorized into pre-emptive or empirical groups based on whether or not there was clinical evidence of invasive fungal infection (IFI) at the start of antifungal treatment, respectively. Clinical outcomes were compared between the two groups after propensity score matching (PSM).
RESULTS: In total, 229 chemotherapy episodes (36 and 193 in the empirical and pre-emptive groups, respectively) were analysed. In the pre-emptive group, broad-spectrum antifungal therapy was administered in 45 (23.3%) episodes. After 1:3 PSM, there were no significant differences between the empirical and pre-emptive groups in terms of the incidence of proven or probable IFI [0/36 (0%) vs 5/97 (5.2%); P=0.323], all-cause mortality [3/36 (8.3%) vs 4/97 (4.1%); P=0.388] and IFI-related mortality [0/36 (0.0%) vs 1/45 (2.2%); P=0.556].
CONCLUSION: The differences in clinical outcomes between empirical and pre-emptive antifungal therapy in patients with AML who received antimould prophylaxis were not significant. Therefore, broad-spectrum antifungal therapy in patients receiving antimould prophylaxis may be delayed until there is clear evidence of IFI.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:62 |
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| Enthalten in: |
International journal of antimicrobial agents - 62(2023), 4 vom: 16. Okt., Seite 106954 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Oh, Sang-Min [VerfasserIn] |
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| Links: |
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| Themen: |
Antimould prophylaxis |
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| Anmerkungen: |
Date Revised 27.09.2023 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1016/j.ijantimicag.2023.106954 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM360946372 |
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| 520 | |a Copyright © 2023 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved. | ||
| 520 | |a INTRODUCTION: This study compared clinical outcomes in patients with acute myelogenous leukaemia (AML) who developed prolonged (≥4 days) febrile neutropenia (FN) and received either empirical or pre-emptive antimould prophylaxis in order to evaluate the need for routine empirical antifungal therapy | ||
| 520 | |a METHODS: This retrospective study reviewed adult patients (aged ≥18 years) with AML who developed prolonged FN and received antimould prophylaxis during induction or re-induction chemotherapy at a single centre between September 2016 and December 2020. Patients were categorized into pre-emptive or empirical groups based on whether or not there was clinical evidence of invasive fungal infection (IFI) at the start of antifungal treatment, respectively. Clinical outcomes were compared between the two groups after propensity score matching (PSM) | ||
| 520 | |a RESULTS: In total, 229 chemotherapy episodes (36 and 193 in the empirical and pre-emptive groups, respectively) were analysed. In the pre-emptive group, broad-spectrum antifungal therapy was administered in 45 (23.3%) episodes. After 1:3 PSM, there were no significant differences between the empirical and pre-emptive groups in terms of the incidence of proven or probable IFI [0/36 (0%) vs 5/97 (5.2%); P=0.323], all-cause mortality [3/36 (8.3%) vs 4/97 (4.1%); P=0.388] and IFI-related mortality [0/36 (0.0%) vs 1/45 (2.2%); P=0.556] | ||
| 520 | |a CONCLUSION: The differences in clinical outcomes between empirical and pre-emptive antifungal therapy in patients with AML who received antimould prophylaxis were not significant. Therefore, broad-spectrum antifungal therapy in patients receiving antimould prophylaxis may be delayed until there is clear evidence of IFI | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Antimould prophylaxis | |
| 650 | 4 | |a Broad-spectrum antifungal therapy | |
| 650 | 4 | |a Invasive fungal infection | |
| 650 | 4 | |a Pre-emptive administration | |
| 650 | 4 | |a Prolonged febrile neutropenia | |
| 700 | 1 | |a Byun, Ja Min |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Chan Mi |e verfasserin |4 aut | |
| 700 | 1 | |a Kang, Chang Kyung |e verfasserin |4 aut | |
| 700 | 1 | |a Shin, Dong-Yeop |e verfasserin |4 aut | |
| 700 | 1 | |a Koh, Youngil |e verfasserin |4 aut | |
| 700 | 1 | |a Hong, Junshik |e verfasserin |4 aut | |
| 700 | 1 | |a Choe, Pyoeng Gyun |e verfasserin |4 aut | |
| 700 | 1 | |a Park, Wan Beom |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Nam Joong |e verfasserin |4 aut | |
| 700 | 1 | |a Yoon, Sung-Soo |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Inho |e verfasserin |4 aut | |
| 700 | 1 | |a Oh, Myoung-Don |e verfasserin |4 aut | |
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