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Invasive mold infections occurred with absence of prophylaxis covering
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2011 ICAAC
Acquisition of invasive mold infections remains frequent for acute leukemia and bone marrow transplant patients with the absence of prophylaxis covering molds outside and inside the hospital, according to research presented at the 2011 Interscience Conference on Antimicrobial Agents and Chemotherapy.
Researchers identified neutropenic patients at risk for invasive mold infections hospitalized in 2009 and 2010 and found an increased incidence of invasive mold infections in acute leukemia and bone marrow transplant patients. Microbiology data and CT scans were reviewed, and episodes of invasive mold infections occurring during neutropenia were classified into possible, probable and proven cases, according to the study.
Researchers found that five of 34 bone marrow transplant patients acquired invasive mold infections outside the hospital and one acquiring invasive mold infections during hospital stay (incidence=3.4%; 95% CI, 0.09-17.8) in 2009 vs. three of 31 bone marrow transplant patients acquiring invasive mold infections outside and eight acquiring invasive mold infections while hospitalized (incidence=30.8; 95% CI, 14.3-51.8) in 2010. Of 26 patients treated for acute leukemia, four acquired invasive mold infections outside and four during hospital stay (incidence=18.2%; 95% CI, 5.2-40.3) in 2009 vs. five of 22 acute leukemia patients acquiring invasive mold infections outside and seven during hospital stay (incidence=41.2%; 95% CI, 18.4-67.1) in 2010.
Because of the results, researchers implemented additional preventive and protective measures, as well as changed the standard prophylaxis from fluconazole 200 mg per day to voriconazole 400 mg per day, according to the study.
For more information:
- Van Delden C. #1121. Presented at: 2011 Interscience Conference on Antimicrobial Agents and Chemotherapy; Sept. 17-20; Chicago.
Disclosure: Dr. Van Delden reports serving as a scientific adviser and receiving consulting fees from Basilea, Merck Sharp & Dohme, Gilead and Pfizer.
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Aggressive treatments for hematologic malignancies are well known as predisposing the patient to a wide array of invasive pathogens otherwise rarely seen in practice. The current study underscores the need for vigilance in this regard for invasive molds. Infections occurred both outside the hospital and while hospitalized in both bone marrow transplant patients and in those with acute leukemia. While the numbers in the series are relatively small, there appeared to be an increasing incidence of these infections and the authors advised additional attention to these invasive pathogens and altering antifungal prophylaxis.
– Paul A. Volberding, MD
Professor and Vice Chair, Department of Medicine, UCSF
Disclosure: Dr. Volberding is an advisor to Bristol-Myers Squibb and on the Data and Safety Monitoring Board for Gilead, TaiMed, and the NIH.
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