Treatment of fungal disease in the setting of neutropenia

Walsh, Thomas J.; Gamaletsou, Maria N.

doi:10.1182/asheducation-2013.1.423

Cited by 59 publications

(54 citation statements)

References 14 publications

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“…Administration of either amphotericin B or CAS is recommended for treatment of azole-resistant Candida species-related bacteremia 29. In the current study, history of antifungal use was found to be associated with azole-resistant Candida species in patients with hematological malignancies (Table 2), indicating that antifungal drug use leads to development of relevant antifungal drug-resistant strains in the environment and patients 1,30. To address this problem, periodic changes in the use of antifungal drugs, such as changing VOR to amphotericin B for invasive Aspergillus and CAS to amphotericin B for empirical antifungal treatment, could be evaluated, but performance of prospective, randomized-controlled studies is needed to identify a solution to this challenge.…”

Section: Discussionmentioning

confidence: 53%

Primary or secondary antifungal prophylaxis in patients with hematological maligancies: efficacy and damage

Gedık¹,

Şimşek²,

Yıldırmak³

et al. 2014

TCRM

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BackgroundPatients with hematological malignancies often develop febrile neutropenia (FN) as a complication of cancer chemotherapy. Primary or secondary antifungal prophylaxis is recommended for patients with hematological malignancies to reduce the risk of invasive fungal infection (IFI). This study retrospectively evaluated the efficacy and potential harm of administration of primary and secondary antifungal prophylaxis to patients with hematological malignancies at one hospital.MethodsAll patients with hematological malignancies older than 14 years of age who had experienced at least one FN attack during chemotherapy while being treated at one hospital between November 2010 and November 2012 were retrospectively evaluated.ResultsA total of 282 FN episodes in 126 consecutive patients were examined during a 2-year study period. The mean patient age was 51.73±14.4 years (range: 17–82 years), and 66 patients were male. Primary prophylaxis with posaconazole was administered to 13 patients and systemic antifungal treatment under induction or consolidation chemotherapy to seven patients. Of 26 patients who received secondary antifungal prophylaxis with either oral voriconazole (n=17) or posaconazole (n=6) during 46 FN episodes, systemic antifungal therapy was administered in 16 of 38 episodes and three of eight episodes, respectively. Secondary antifungal prophylaxis with caspofungin was found effective in treating six FN episodes in three patients who had experienced at least two persistent candidemia attacks. The mortality rates associated with IFI were 9% in the first year, 2% in the second year, and 6% overall. The mortality rates associated with candidemia were 33% in the first year, 22% in the second year, and 27% overall.ConclusionPrimary antifungal prophylaxis should be administered to selected patients on the basis of consideration of efficacy, cost, and potential harm. Use of secondary prophylaxis may reduce systemic antifungal use and IFI frequency but may increase risk of colonization and infection with azole-resistant fungal strains.

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Section: Discussionmentioning

confidence: 53%

Primary or secondary antifungal prophylaxis in patients with hematological maligancies: efficacy and damage

Gedık¹,

Şimşek²,

Yıldırmak³

et al. 2014

TCRM

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“…Recently, Nucci et al, retrospectively analyzed 233 cases of invasive fusariosis and found that neutropenia at the end of treatment was associated with poor prognosis by multivariate analysis [6]. Other authors also found that the length of neutropenia is significantly associated with a poor outcome of several fungal infections [7]. Although almost all the patients described in this review were neutropenic at the time of diagnosis of fungal infection, the length of neutropenia prior to infection as well its persistence or recovery over time were often not reported, making this point prevalence detection difficult to interpret.…”

Section: Discussionmentioning

confidence: 96%

Epidemiology and outcome of systemic infections due to saprochaete capitata: case report and review of the literature

et al. 2014

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A case of systemic infection due to Saprochaete capitata in a patient with chronic lymphocytic leukemia is described. A review of the literature was conducted to identify all reported cases of this infection described between 1977 and August 2013. One hundred and four cases (included the present one) were identified. The median age of the patients was 56 years and 56% were males. Comorbidities included acute myeloid leukemia (52%), acute lymphoid leukemia (22%), other hematological malignancies (13%) and non-hematological diseases (9%). At the time of the infection, 82% of the patients were neutropenic. In 75% of the cases, the yeast was isolated from blood culture, in 25% from other sterile sites. Empirical treatment was done in 36% of the cases. Fifty-eight percent of the individual cases were treated with a combination or a sequential antifungal therapy. Amphotericin B was the antifungal drug most commonly used, followed by voriconazole and itraconazole. The overall crude mortality was 60%. Saprochaete capitata causes life-threatening infections in neutropenic patients. This comprehensive literature review may help the clinician to optimize the management of this rare infection.

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“…This is supported by reports demonstrating that candidemia is an important complication that occurs with a high frequency in neutropenic patients [31] and that prolonged neutropenia results in susceptibility to infection by Candida spp. and Aspergillus spp.…”

Section: Disease State and Treatments Compromising Immune Competencementioning

confidence: 55%

Pharmacodynamic studies of voriconazole: informing the clinical management of invasive fungal infections

Job

Olson

Constance

et al. 2016

Expert Review of Anti-infective Therapy

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The objective of this review is to summarize the pharmacodynamic properties of voriconazole and to provide considerations for potential optimal dosing strategies. Studies have demonstrated superior clinical response when an AUC/MIC >25 or Cmin/MIC >1 is attained in adult patients, correlating to a trough concentration range as narrow as 2-4.5 mg/L; however, these targets are poorly established in the pediatric population. Topics in this discussion include voriconazole use in multiple age groups, predisposing patient factors for IFI, and considerations for clinicians managing IFI. Expert commentary: The relationship between voriconazole dosing and exposure is not well defined due to the large inter- and intra-subject variability. Development of comprehensive decision support tools for individualizing dosing, particularly in children who require higher dosing, will help to increase the probability of achieving therapeutic efficacy and decrease sub-therapeutic dosing and adverse events.

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Treatment of fungal disease in the setting of neutropenia

Cited by 59 publications

References 14 publications

Primary or secondary antifungal prophylaxis in patients with hematological maligancies: efficacy and damage

Primary or secondary antifungal prophylaxis in patients with hematological maligancies: efficacy and damage

Epidemiology and outcome of systemic infections due to saprochaete capitata: case report and review of the literature

Pharmacodynamic studies of voriconazole: informing the clinical management of invasive fungal infections

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