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Primary antifungal prophylaxis with micafungin in patients with haematological malignancies: real‐life data from a retrospective single‐centre observational study
Author(s) -
Nachbaur David,
Angelova Olga,
OrthHöller Dorothea,
Ditlbacher Adelheid,
Lackner Michaela,
Auberger Jutta,
LassFlörl Cornelia
Publication year - 2015
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.12426
Subject(s) - micafungin , posaconazole , neutropenia , medicine , candida krusei , echinocandin , amphotericin b , fluconazole , chemotherapy , antifungal , dermatology
Mould‐active antifungal prophylaxis is increasingly used in patients at risk for invasive fungal disease. Between June 2011 and June 2012, one hundred patients with various haematological malignancies at risk for invasive fungal disease received primary antifungal prophylaxis with intravenous micafungin at a daily dosage of 50 mg during neutropenia. The median number of days on micafungin prophylaxis was 14 (range, 6–48 d). The incidence of proven and probable breakthrough invasive fungal diseases ( bIFD s) was 6% and 3%, respectively. There were two bloodstream infections caused by yeasts or yeast‐like fungi ( Candida krusei , Trichosporon asahii ) in two patients during the neutropenic phase after allogeneic haematopoietic stem cell transplantation. Four proven bIFD s caused by non‐ Aspergillus moulds and three cases of probable pulmonary bIFD s were documented during the neutropenic phase after induction/consolidation chemotherapy for acute leukaemia. Colonisation with Candida spp. was documented in 51% of the patients with none of the isolates being in vitro micafungin resistant. Compared to a historical control, receiving primary prophylaxis with posaconazole micafungin is at least as effective in preventing IFD. In both cohorts, bIFD s were exclusively caused by emerging pathogens with a highly preserved in vitro sensitivity to amphotericin B.