Comparison of fluconazole and posaconazole for fungal prophylaxis in high-risk patients with hematological malignity

Abstract

Objective: To compare the frequency of fungal infection and mortality rates in patients with hematological malignity and receiving either flucanazole (FLU) or posaconazole (POS) prophylaxis. Methods: This retrospective, observational study investigated fungal prophylaxis in patients with a high risk of invasive fungal infections (IFIs) and diagnosed with hematological malignity at our hospital hematology clinic between 01.01.2011 and 01.01.2013. FLU (n=70) was the prophylactic regimen between 2011 and 2012 which was replaced by POS (n=35) in the following period. The incidence and mortality rates of IFIs developing in the two periods were compared. Results: The incidence of IFI in patients administered FLU prophylaxis was 22/70 (31%), compared to 13/35 (37%) in the patients receiving POS. Incidence of invasive pulmonary aspergillosis (IPA) in the FLU group was 21/70 (31%), compared to 9/35 (26%) in the POS group. The mortality rate in the group receiving FLU prophylaxis was 17 (24%), compared to 4 (11%) in the POS group. The difference was attributed to causes other than fungal infection. Results of subgroup analysis performed for AML were similar to the general findings in terms of both incidences of fungal infection and of mortality levels. In multivariate analysis, mean duration of neutropenia was correlated with prophylaxis failure. Conclusion: We conclude that both agents can be successfully used in fungal infection prophylaxis for patients at high risk for IFI.

Keywords

• Fungal prophylaxis, invasive fungal infections, mortality

Comparison of fluconazole and posaconazole for fungal prophylaxis in high-risk patients with hematological malignity

Öz

Amaç: Bu çalışmada hematolojik malignitesi olan ve flukonazol (FLU) veya posakonazol (POS) proflaksisi uygulanan hastalarda görülen fungal enfeksiyon sıklığı ve mortalite oranları karşılaşıldı. Yöntemler: Bu retrospektif, gözlemsel çalışmada 01 Ocak 2011-01 Ocak 2013 tarihleri arasında hastanemiz hematoloji kliniğinde hematolojik malignite tanısıyla izlenmekte olan hastalara verilen antifungal profilaksiler değerlendirildi. Birer yıllık 2 dönemin ilkinde, hastalara proflaktik olarak FLU, 2.dönemde ise POS uygulandı. Bulgular: FLU proflaksisi alan hastalarda görülen fungal enfeksiyon sıklığı 22/70 (31%) iken, POS alan hastalarda 13/35 (37%) olduğu görüldü. İnvaziv pulmoner aspergilloz (İPA) görülme sıklığı FLU kolunda 21/70 (31%) bulunurken, POS kolunda bu oran 9/35 (%26) bulundu. FLU proflaksisi alan gruptan 17 hasta öldü (%24), POS alan gruptan ise 4 (%11) hasta öldü. Bu farkın fungal enfeksiyon dışı nedenlerden kaynaklandığı düşünüldü. AML için yapılan subgrup analizinde fungal enfeksiyon sıklığı ve mortalite oranları bakımından sonuçlar, genel sonuçlarla benzerdi. Çoklu varyasyon analizinde hastalardaki ortalama nötropeni süresinin uzunluğuyla fungal proflaksi başarısızlığı arasında ilişki bulundu.Sonuç: Her iki ajanın da yüksek riskli hastalardaki fungal enfeksiyon proflaksisinde başarıyla kullanılabileceği sonucuna varıldı

Anahtar Kelimeler

• Fungal proflaksi, invaziv fungal enfeksiyonlar, mortalite

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