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Empirical antifungal therapy in selected patients with persistent febrile neutropenia

Abstract number: P1736

Martín-Peña A., Aguilar-Guisado M., Cisneros J.M., Cordero E., Espigado I., Parody R., Pachón J.

Objectives: The aim of this study is to analyze the incidence and related mortality of invasive fungal infection (IFI) in patients with persistent febrile neutropenia, using empiric antifungal therapy (EAT) only in selected patients by risk factors and clinical criteria.

Methods: Prospective observational study including every persistent febrile neutropenia episodes in patients with haematological malignancies or stem cell transplantation (SCT) recipients admitted in the Haematology Service from October 2007 to November 2008. A diagnostic and therapeutic protocol based in clinical criteria and risk factors was applied in every episode in order to select patients for EAT indication. Comparative analysis of incidence of proven or probable IFI and IFI-related mortality in patients with persistent febrile neutropenia according to the indication or not of EAT.

Results: Fifty three episodes PFN in forty six patients were included. The 56.5% were male and the median age in years was 51 (15–71). The most frequent haematological malignancies were acute leukaemia (36.9%) and lymphoma (26.1%). Eighteen patients were SCT recipients, 50% allogeneic. The 21.7% were IFI-high risk patients. The mean of duration of neutropenia and fever were 14 days (range: 6–63) and 11 days (range: 4–33) respectively. A diagnostic of proven or probable infection was established in 79.2% of the cases. The most frequent clinical syndromes were: respiratory (35.8%) and non focused fever (35.8%). EAT was indicated in thirty two episodes (60.4%) with a median of duration of 10 days (range: 2–164); in the rest of episodes (n = 21) EAT was no indicated. The overall IFI incidence was 17% (n = 9). In the group that received EAT, nine patients developed IFI (28.1%), in comparison with no-one patient in the group that did not receive EAT. The 30 days-global mortality was 18.9%, 28.1% in the group that received EAT and 4.8% in the group that did not received it. The IFI-related mortality in the group that received EAT was 6.2% and 0% in the group that did not received EAT.

Conclusion: These data suggest that EAT in selected patients used in the basis of clinical criteria and risk factors, may be effective and safe in the management of PFN and avoid over-treatment.

Session Details

Date: 16/05/2009
Time: 00:00-00:00
Session name: 19th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Helsinki, Finland, 16 - 19 May 2009
Presentation type:
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