Empirical antifungal treatment for diagnosed and undiagnosed invasive fungal disease in patients with hematologic malignancies

Deng, Qi; Lv, Hai‑Rong; Lin, Xuemei; Zhao, Mingfeng; Geng, Lanlan; Li, Yuming

doi:10.1080/03007995.2017.1386167

Cited by 5 publications

(2 citation statements)

References 28 publications

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“…Invasive fungal infection is one of the serious etiologies of chemotherapy-induced neutropenia (14,45). As a common approach, empirical therapy has been used in treating IFI patients for years, but administering empirical antifungal agents may have certain problems, such as overtreatment or higher expenses and due to lack of trustworthy data, the efficiency of this method is still debatable (16,38,46).…”

Section: Discussionmentioning

confidence: 99%

The Value of Nasal and Oral Clinical Examination in Febrile Neutropenic Patients for Initiating Antifungal Therapy as a Preemptive Method

et al. 2022

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BackgroundInvasive fungal infections (IFIs) are complications that lead to mortality and morbidity in hematologic malignancies. The time of starting antifungal therapy is vital. Preemptive antifungal therapy has appeared recently as a new policy for the management of IFIs based on noninvasive ways in neutropenic patients.MethodsWe enrolled leukemia patients with neutropenia after chemotherapy in Imam Khomeini Hospital Complex, Tehran, Iran. Patients who entered the neutropenic phase were divided into two categories (empirical and preemptive) for receiving antifungal agents. The patients were clinically examined in the preemptive group every day to find IFIs. As soon as clinical evidence of IFIs was observed, antifungal was prescribed. The empirical group patients received antifungals based on the ward protocol. Based on the data in each group, the diagnostic and therapeutic results of cases are followed-up to 3 months. To compare percentages between the two groups, the chi-squared test was used. And to compare two means between the two groups, the independent t-test was used. All the statistical analyses were done in the Statistical Package for the Social Sciences (SPSS) version 24 software (IBM Corporation, Armonk, New York, USA).ResultsWe assessed 132 leukemic patients with inclusion and exclusion criteria. Eventually, 80 patients were enrolled. The mean age was 35.52 years. Demographics data and distribution of leukemia type show no significant differences between the two groups. Despite a higher percentage of IFIs discovered in the preemptive group than the empirical group (25 vs. 18.75%, respectively), but data show no significant differences. The average days of IFIs diagnosis since the beginning of neutropenia in the empirical group were 9.5 days while in the preemptive group, the average days were 5.4 days (p < 0.05). Totally, there were 15 patients with a proven IFI in each group (40% in the empirical group and 60% in the preemptive group). Results significantly show an increase in surgical sinus debridement in the empirical groups (83.3%) vs. the preemptive groups (55.5%), (p < 0.05). The mortality rate differed significantly among the two groups; it was 7.5% in the preemptive group and 25% in the empirical group (p < 0.05).ConclusionDaily oral and nasal cavities examination to find the symptoms of IFIs and then start preemptive antifungal agents may be able to lead to accurate diagnosis, earlier treatment, and decreasing sinus surgery debridement in leukemia patients with neutropenia.

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Section: Discussionmentioning

confidence: 99%

The Value of Nasal and Oral Clinical Examination in Febrile Neutropenic Patients for Initiating Antifungal Therapy as a Preemptive Method

et al. 2022

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“…IFD is a signi cant cause of morbidity and mortality for hematologic patients. The risk of IFDs is dramatically increased in patients with hematologic disease, who are undergoing intensive chemotherapy or stem cell transplantation, as well as in other immune compromised populations [15]. The most commonly identi ed fungal species associated with IFD are Candida, Aspergillus, Cryptococcus and Pneumocystis [16].…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study of Invasive Fungal Disease Treated by High Dosage Micafungin Therapy VS Standard Micafungin Therapy Among Patients with Hematologic Diseases.

Zhang

et al. 2021

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Background: The standard (150mg/day) micafungin treatment regimen, is an effective and well tolerated empirical therapy for invasive fungal disease (IFD) among hematologic patients; however, experience with high dosage (200-300mg/day) micafungin treatment is limited. We retrospectively evaluated both safety and effectiveness of micafungin as an empirical antifungal therapy via standard and high dosage treatments for IFD.Methods: Patients were considered to be qualified for this analysis if they were proven, probable, or possible diagnosed as IFD. Patients without any previous exposure to an echinocandin were included; for those who changed treatment dosages and had previously received another systemic therapy except fluconazole for prevention were excluded. Safety and effectiveness were evaluated in all participated patients. IFD was diagnosed and classified according to standards defined by both European Organization for Research and Treatment of Cancer / Invasive Fungal Infections Cooperative Group, and the National Institute of Allergy and Infectious Diseases Mycoses Study Group Consensus Group.Results: Totally 72 hematologic patients participated this study. 45 patients were received a standard (150mg/day)micafungin treatment, and 27 patients were received a high dosage (200-300mg/day)micafungin treatment. Neutropenia status were similar between two groups (37.78% and 33.33%), so were other underlying risk factors. The mean duration of therapy were 15.27 days (Range: 7-47 days) in standard micafungin group, and 14.96 days (Range: 7-51 days) in high dosagemicafungin group. Drug related adverse events (AEs) occurred in 11.11% of patients received the standard regimen, and 14.81% of patients received the high dosage regimen (difference, 3.70%; 95% confidence interval [CI], -5.75% to 10.89%; statistically insignificant). The most common drug related AEs in the standard and high dosage treatment groups were liver dysfunction. Only 1 patient discontinued standard micafungin treatment, because liver function test value is 5 times greater than the upper limit of normal value. 86.67% of patients from standard treatment group, and 88.89% of patients from high dosage treatment group had favorable overall responses (difference, 2.22%; 95% CI, -4.94% to 8.64%; statistically insignificant).Conclusion: Both micafungin dosing treatments were effective, and well tolerated among hematologic patients with invasive fungal infection. Therefore, there hasn’t arisen any safety concern of high dosage(200-300mg/day) micafungin treatment.

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Amphotericin B/itraconazole/voriconazole

2018

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Empirical antifungal treatment for diagnosed and undiagnosed invasive fungal disease in patients with hematologic malignancies

Abstract: Empirical antifungal treatment could help save the lives of some patients with severe infections who are strongly suspected of having IFD.

Cited by 5 publications

References 28 publications

The Value of Nasal and Oral Clinical Examination in Febrile Neutropenic Patients for Initiating Antifungal Therapy as a Preemptive Method

The Value of Nasal and Oral Clinical Examination in Febrile Neutropenic Patients for Initiating Antifungal Therapy as a Preemptive Method

A Retrospective Study of Invasive Fungal Disease Treated by High Dosage Micafungin Therapy VS Standard Micafungin Therapy Among Patients with Hematologic Diseases.

Amphotericin B/itraconazole/voriconazole

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