BACKGROUND: Giving antifungal therapy exclusively to selected patients with persistent febrile neutropenia may avoid over-treatment without increasing mortality. The aim of this study was to validate an innovative diagnostic and therapeutic approach based on assessing patients' risk profile and clinical criteria in order to select those patients requiring antifungal therapy. The efficacy of this approach was compared to that of universal empirical antifungal therapy. DESIGN AND METHODS: This was a prospective study which included all consecutive adult hematology patients with neutropenia and fever refractory to 5 days of empirical antibacterial therapy admitted to a teaching hospital in Spain over a 2-year period. A diagnostic and therapeutic approach based on clinical criteria and risk profile was applied in order to select patients for antifungal therapy. The sensitivity, specificity and negative predictive value of this approach and also the overall success rate, according to the same criteria of efficacy described in classical clinical trials, were analyzed. RESULTS: Eighty-five episodes were included, 35 of them (41.2%) in patients at high risk of invasive fungal infections. Antifungal therapy was not indicated in 33 episodes (38.8%). The overall incidence of proven and probable invasive fungal infections was 14.1%, all of which occurred in patients who had received empirical antifungal therapy. The 30-day crude mortality rate was 15.3% and the invasive fungal infection-related mortality rate was 2.8% (2/72). The overall success rate following the diagnostic and therapeutic approach was 36.5% compared with 33.9% and 33.7% obtained in the trial by Walsh et al. The sensitivity, specificity and negative predictive value of the study approach were 100%, 52.4% and 100%, respectively. CONCLUSIONS: Based on the high negative predictive value of this diagnostic and therapeutic approach in persistent febrile neutropenia patients with hematologic malignancies or patients who have received a hematopoietic stem cell transplant, the approach is useful for identifying patients who are not likely to develop invasive fungal infection and do not, therefore, require antifungal therapy. The effectiveness of the strategy is similar to that of universal empirical antifungal therapy reported in controlled trials.
BACKGROUND: Giving antifungal therapy exclusively to selected patients with persistent febrile neutropenia may avoid over-treatment without increasing mortality. The aim of this study was to validate an innovative diagnostic and therapeutic approach based on assessing patients' risk profile and clinical criteria in order to select those patients requiring antifungal therapy. The efficacy of this approach was compared to that of universal empirical antifungal therapy. DESIGN AND METHODS: This was a prospective study which included all consecutive adult hematology patients with neutropenia and fever refractory to 5 days of empirical antibacterial therapy admitted to a teaching hospital in Spain over a 2-year period. A diagnostic and therapeutic approach based on clinical criteria and risk profile was applied in order to select patients for antifungal therapy. The sensitivity, specificity and negative predictive value of this approach and also the overall success rate, according to the same criteria of efficacy described in classical clinical trials, were analyzed. RESULTS: Eighty-five episodes were included, 35 of them (41.2%) in patients at high risk of invasive fungal infections. Antifungal therapy was not indicated in 33 episodes (38.8%). The overall incidence of proven and probable invasive fungal infections was 14.1%, all of which occurred in patients who had received empirical antifungal therapy. The 30-day crude mortality rate was 15.3% and the invasive fungal infection-related mortality rate was 2.8% (2/72). The overall success rate following the diagnostic and therapeutic approach was 36.5% compared with 33.9% and 33.7% obtained in the trial by Walsh et al. The sensitivity, specificity and negative predictive value of the study approach were 100%, 52.4% and 100%, respectively. CONCLUSIONS: Based on the high negative predictive value of this diagnostic and therapeutic approach in persistent febrile neutropeniapatients with hematologic malignancies or patients who have received a hematopoietic stem cell transplant, the approach is useful for identifying patients who are not likely to develop invasive fungal infection and do not, therefore, require antifungal therapy. The effectiveness of the strategy is similar to that of universal empirical antifungal therapy reported in controlled trials.
Authors: Walter T Hughes; Donald Armstrong; Gerald P Bodey; Eric J Bow; Arthur E Brown; Thierry Calandra; Ronald Feld; Philip A Pizzo; Kenneth V I Rolston; Jerry L Shenep; Lowell S Young Journal: Clin Infect Dis Date: 2002-02-13 Impact factor: 9.079
Authors: Thomas J Walsh; Peter Pappas; Drew J Winston; Hillard M Lazarus; Finn Petersen; John Raffalli; Saul Yanovich; Patrick Stiff; Richard Greenberg; Gerald Donowitz; Mindy Schuster; Annette Reboli; John Wingard; Carola Arndt; John Reinhardt; Susan Hadley; Robert Finberg; Michél Laverdière; John Perfect; Gary Garber; Giuseppe Fioritoni; Eli Anaissie; Jeanette Lee Journal: N Engl J Med Date: 2002-01-24 Impact factor: 91.245
Authors: Juergen Loeffler; Michael Ok; Oliver C Morton; Markus Mezger; Hermann Einsele Journal: Curr Top Microbiol Immunol Date: 2010 Impact factor: 4.291
Authors: S Ascioglu; J H Rex; B de Pauw; J E Bennett; J Bille; F Crokaert; D W Denning; J P Donnelly; J E Edwards; Z Erjavec; D Fiere; O Lortholary; J Maertens; J F Meis; T F Patterson; J Ritter; D Selleslag; P M Shah; D A Stevens; T J Walsh Journal: Clin Infect Dis Date: 2001-11-26 Impact factor: 9.079
Authors: M Boogaerts; D J Winston; E J Bow; G Garber; A C Reboli; A P Schwarer; N Novitzky; A Boehme; E Chwetzoff; K De Beule Journal: Ann Intern Med Date: 2001-09-18 Impact factor: 25.391
Authors: Raoul Herbrecht; David W Denning; Thomas F Patterson; John E Bennett; Reginald E Greene; Jörg-W Oestmann; Winfried V Kern; Kieren A Marr; Patricia Ribaud; Olivier Lortholary; Richard Sylvester; Robert H Rubin; John R Wingard; Paul Stark; Christine Durand; Denis Caillot; Eckhard Thiel; Pranatharthi H Chandrasekar; Michael R Hodges; Haran T Schlamm; Peter F Troke; Ben de Pauw Journal: N Engl J Med Date: 2002-08-08 Impact factor: 91.245
Authors: Thomas J Walsh; Hedy Teppler; Gerald R Donowitz; Johan A Maertens; Lindsey R Baden; Anna Dmoszynska; Oliver A Cornely; Michael R Bourque; Robert J Lupinacci; Carole A Sable; Ben E dePauw Journal: N Engl J Med Date: 2004-09-30 Impact factor: 91.245
Authors: R Phillip Dellinger; Jean M Carlet; Henry Masur; Herwig Gerlach; Thierry Calandra; Jonathan Cohen; Juan Gea-Banacloche; Didier Keh; John C Marshall; Margaret M Parker; Graham Ramsay; Janice L Zimmerman; Jean-Louis Vincent; Mitchell M Levy Journal: Crit Care Med Date: 2004-03 Impact factor: 7.598
Authors: Sabine Mousset; Dieter Buchheidt; Werner Heinz; Markus Ruhnke; Oliver A Cornely; Gerlinde Egerer; William Krüger; Hartmut Link; Silke Neumann; Helmut Ostermann; Jens Panse; Olaf Penack; Christina Rieger; Martin Schmidt-Hieber; Gerda Silling; Thomas Südhoff; Andrew J Ullmann; Hans-Heinrich Wolf; Georg Maschmeyer; Angelika Böhme Journal: Ann Hematol Date: 2013-09-12 Impact factor: 3.673
Authors: Marina Machado; Esther Chamorro de Vega; María Del Carmen Martínez-Jiménez; Carmen Guadalupe Rodríguez-González; Antonio Vena; Raquel Navarro; María Isabel Zamora-Cintas; Caroline Agnelli; María Olmedo; Alicia Galar; Jesús Guinea; Ana Fernández-Cruz; Roberto Alonso; Emilio Bouza; Patricia Muñoz; Maricela Valerio Journal: J Fungi (Basel) Date: 2021-01-17
Authors: Seong Hyun Jeong; Dae Young Kim; Jun Ho Jang; Yeung-Chul Mun; Chul Won Choi; Sung-Hyun Kim; Jin Seok Kim; Joon Seong Park Journal: Ann Hematol Date: 2015-11-24 Impact factor: 3.673