Premium
Primary antifungal prophylaxis: decrease of invasive fungal disease incidence and reduction of risk factors in haematological patients in a 5‐year retrospective study
Author(s) -
Li Yan,
Liu Mingjuan,
Zhai Bing,
Zhao Xiaoli,
Wang Lijun,
Li Honghua,
Wang Shuhong,
Zhu Haiyan,
Wang Quanshun,
Gao Chunji,
Huang Wenrong,
Yu Li
Publication year - 2018
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.13711
Subject(s) - medicine , neutropenia , incidence (geometry) , odds ratio , retrospective cohort study , risk factor , chemotherapy , physics , optics
Background Invasive fungal disease (IFD) is a major cause of morbidity and mortality in patients with haematological malignancies. Aim To evaluate the efficacy and rationality of primary antifungal prophylaxis (PAP) in a 5‐year real‐life setting and choose an appropriate PAP strategy. Methods Clinical data of patients were retrospectively reviewed and IFD was diagnosed using the revised diagnostic criteria. The efficacy of PAP and the risk factors for IFD, especially the rationality of PAP, were evaluated. Results Of the 1340 patients enrolled, 749 patients received PAP (55.9%), and IFD occurred in 157 patients: 51 (6.8%) in the PAP group and 106 (17.9%) in the non‐PAP group ( P = 0.000). The IFD‐related mortality was 10.1 and 29.7% in the PAP group and non‐PAP group ( P = 0.000) respectively. PAP was an independent protective factor for IFD (odds ratio = 0.183, 95% confidence interval: 0.122–0.274, P = 0.000) and could reduce the effect of risk factors, such as allogeneic haemopoietic stem cell transplantation, prolonged neutropenia and corticosteroid. The IFD incidence was not significantly different among different PAP regimens and PAP start time subgroups, and it was lowest (4.2%) when PAP started after a short period of neutropenia (1–10 days). Conclusion PAP is necessary and efficient to prevent IFD in haematological patients, and the real‐life PAP strategy is reasonable. Different drugs can be chosen, and it is better to start PAP as soon as neutropenia begins.