Literatür Detay Bilgisi
Universal antifungal therapy is not needed in persistent febrile neutropenia: a tailored diagnostic and therapeutic approach.
Yazarlar : Aguilar-Guisado M, Martin-Pena A, Espigado I, Ruiz Perez de Pipaon M, Falantes J, de la Cruz F, Cisneros JM.
Yayın : Haematologica.
Yayın Yılı : 2011
Pubmed Linki : http://www.ncbi.nlm.nih.gov/pubmed/22058202
Konu : Enfeksiyon
Literatür İçeriği :
Abstract
Background. Antifungal therapy exclusively in 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 risk profile and clinical criteria for selecting patients to receive antifungal therapy and to compare its efficacy with universal empirical antifungal therapy. Design and methods. This was a prospective study which included all consecutive hematological adult patients with neutropenia and fever refractory to 5 days of empiric 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. Sensitivity, specificity and negative predictive value of this approach and also overall successful response 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 invasive fungal infection high-risk patients. Antifungal therapy was not indicated in 33 episodes (38.8%). The overall incidence of proven and probable invasive fungal infection was 14.1%, all of them in patients who had received empirical antifungal therapy. The 30 day-crude mortality was 15.3% and invasive fungalinfection-related mortality was 2.8% (2/72). The overall successful response following the diagnostic and therapeutic approach was 36.5% compared with 33.9% and 33.7% obtained in the trial of Walsh et al. 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 neutropenic patients with hematological malignancies or hematopoietic stem cell transplant recipients, it is useful for identifying patients who are not likely to develop invasive fungal infection, therefore do not require antifungal therapy, and with a effectiveness similar to that reported in controlled trials which indicate empirical antifungal therapy universally.Konusu Aynı Olan Diğer Materyaller
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