Evaluation of Antifungal Treatment Strategies in Febrile Neutropenic Episodes of High-Risk Hematologic Malignancies: A Single Center Retrospective Study

Abstract

Background Febrile neutropenic patients are at high risk for developing invasive fungal infection (IFI). Currently, two treatment strategies, empiric and preemptive, are used in febrile neutropenic patients with IFI. This study aimed to evaluate empirical and preemptive treatment strategies in patients with high-risk hematologic malignancies. Methods We retrospectively analyzed 402 febrile neutropenic attacks in 281 patients with hematological malignancies hospitalized in a university hospital hematology clinic. Between June 2006 and January 2009, 154 febrile neutropenic episodes of 104 patients who met the study eligibility criteria were included. Patients who received antibiotic and antifungal treatment for febrile neutropenia were retrospectively recorded. Patients treated with empiric and preemptive approaches were identified and compared with statistical methods. Results Antifungal treatment was initiated as empiric treatment in 62 (40%), preemptive therapy in 55 (36%) (subgroups; 45 [29%] possible-IFI and 10 [7%] probable-IFI), and 37 (24%) for secondary prophylaxis. In terms of length of hospitalization and all-cause mortality, no statistically significant results were found when patients receiving empiric and preemptive treatment were compared. (p>0.05). Conclusion In patients with high-risk hematologic malignancies, even if empiric treatment is initiated, a dynamic approach that can be summarized as persistently trying to obtain evidence by using ancillary diagnostic tools and early termination of therapy in unnecessary cases seems appropriate.

Keywords

• febrile neutropenia
• invasive fungal infections
• empiric-preemptive therapy
• High-risk hematologic malignancy

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