An early CT-diagnosis-based treatment strategy for invasive fungal infection in allogeneic transplant recipients using caspofungin first line: an effective strategy with low mortality
| Autor: | C Dearden, Faith E. Davies, Jennifer Treleaven, Fiona L Dignan, Bronwen E. Shaw, Michael Potter, Mark Ethell, Unell Riley, Stephen O Evans, Gareth J. Morgan |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Male medicine.medical_specialty Antifungal Agents Time Factors Allogeneic transplantation Adolescent Neutropenia law.invention Echinocandins Lipopeptides chemistry.chemical_compound Pharmacotherapy Randomized controlled trial Caspofungin law Internal medicine Humans Transplantation Homologous Medicine Mycosis Aged Transplantation business.industry Hematopoietic Stem Cell Transplantation Hematology Middle Aged medicine.disease Surgery Mycoses chemistry Hematologic Neoplasms Female Tomography X-Ray Computed business Febrile neutropenia |
| Zdroj: | Bone Marrow Transplantation. 44:51-56 |
| ISSN: | 1476-5365 0268-3369 |
| Popis: | Empirical antifungal therapy is frequently used in allogeneic transplant patients who have persistent febrile neutropenia and can be associated with high cost, toxicity and breakthrough infections. There are limited reports of strategies for early diagnosis of invasive fungal infection (IFI) and, to our knowledge, no reports of treatment strategies based only on high-resolution computerized tomography (HRCT) scans. We used an early treatment strategy for IFI in 99 consecutive patients undergoing allogeneic transplantation. Patients received caspofungin if they had antibiotic-resistant neutropenic fever for more than 72 h and a positive HRCT scan. Fifty-three of 99 patients (54%) had antibiotic-resistant neutropenic fever at 72 h and would have received parenteral antifungal treatment if an empirical approach had been used. The HRCT-based strategy reduced the use of parenteral antifungal agents to 17/99 patients (17%), a 68% reduction. No subsequent diagnoses of IFI occurred within 100 days in patients with a negative HRCT. Only one patient died from IFI within 100 days. These data suggest that this non-empirical strategy may be feasible and that caspofungin may be effective in this setting. A randomized controlled trial is warranted to further assess these results. |
| Databáze: | OpenAIRE |
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