Background Invasive aspergillosis (IA) is a serious problem in haematology patients, especially in patients with acute myeloblastic leukaemias (AML) and allogeneic haematopoietic stem cell transplant (allo-HSCT) recipients. Mould-active prophylaxis is increasingly used in patients at risk of IA, but its effectiveness is still unknown.
Purpose To describe the antifungal prophylaxis (AP) in patients with haematological disease diagnosed with IA.
Material and methods An observational study was performed in the Haematology Unit of a tertiary centre. All patients diagnosed with IA were prospectively recorded from January 2012 to December 2013. The information about antifungal prophylaxis (AP) prescriptions was obtained from the electronic centre database.
Results Thirty-eight invasive fungal infections (IFIs) in 37 patients were evaluated, 23 (60.5%) were men. Mean age was 51 (20–79) years. The diagnoses were: acute leukaemia (44.7%, n = 17), allo-HSCT (34.2%, n = 13) and other (21.1, n = 8). IFI diagnosis was: probable (89.5%, n = 34) and proven (10.5%, n = 4). 6 (15.8%) patients had a previous history of IFI (50% aspergillosis and 50% candidiasis). 57.9% (n = 22) of cases had not had AP versus 42.1% (n = 19) who had. The AP was: primary (75%, n = 12) and secondary (25%, n = 4). The antifungal drugs used were: fluconazole (50%, n = 8), posaconazole (37.5%, n = 6) and voriconazole (12.5%, n = 2). 26.3% (n = 10) of IFIs were cured. In cases where the patient died (73.7%, n = 28), death was attributed to IFI in 35.7% (n = 10) of patients, 70% (n = 7) of whom had not received AP. Death was not attributed to IFI in 64.3% (n = 18) of patients.
Conclusion IA is frequent in haematology patients in spite of antifungal prophylaxis and the prognosis for patients diagnosed with this infection remains being poor. In over half the cases of IFI no antifungal prophylaxis had been attempted. The most used antifungal drug was fluconazole, which has no activity against Aspergillus spp. In the vast majority of IFI-attributable deaths, prophylaxis had not been attempted.
These results have prompted the review of hospital AP protocols to accurately define patient groups at greatest risk of IFI and, when appropriate, to initiate effective antifungal prophylaxis.
Br J Haematol 2011;153:681–97
ReferenceNo conflict of interest.
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