Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Strohmeier, A.
Antifungal agents and Invasive fungal infections (IFI´s)
in hematological malignancies: the AIHM study
[ Diplomarbeit ] Graz Medical University; 2012. pp. 65
[OPEN ACCESS]
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Hönigl Martin
- Krause Robert
- Altmetrics:
- Abstract:
- Aim Invasive fungal infections in patients with hematological malignancies continue to be a major problem resulting in morbidity, mortality and health care related costs. To provide clarification and uniformity in the diagnosis of invasive fungal infections, the EORTC/MSG developed guidelines to define these infections. On the basis of the EORTC/MSG criteria, patients were classified into ¿proven, probable and possible¿ IFI. In this context, Galactomannan-Testing (GM), a method for the evidence of Aspergillus antigen, plays an important role. Our study dealt with the incidence of opportunistic invasive fungal infections in patients with hematological malignancies, associated host factors, prescribed antifungal therapy and the use of Galactomannan as an important and sensitive tool for the early diagnosis. Method In this prospective study of the Division of Hematology at the Medical University of Graz, 729 patients were included of whom 129 patients received an antifungal therapy. The duration of study was a total of eight months, from April 2010 until October 2010. Data of the 129 patients with antifungal therapy were collected twice a week and contained underlying diseases, antifungal therapy and dosage, as well as duration and reason for treatment. In the case of IFI, patients were classified into the EORTC/MSG categories of ¿proven, probable and possible¿ and accurately examined concerning the host factors, fungal species and the outcome after twelve weeks. Results Throughout this study, 200 courses of antifungal agents were administered. The most common antifungal agent was posaconazole in 81/129 cases (63%), followed by caspofungin in 65/129 (50%) cases, itraconazole in 19/129 (15%) and voriconazole in 18/129 (14%) patients. Liposomal amphotericin B was used in 9/129 (7%) patients, whilst fluconazole was only used in 7/129 (5%) patients. 74/129 (57%) patients were treated prophylactically, 57/129 (44%) empirically, 39/129 (30%) preemptively and 8/129 patients (6%) were treated directly. 9/28 were possible, 13/28 were probable and 6/28 patients with antifungal therapy were proven IFI. 24/28 patients with IFI had an IMI of whom 9/24 were possible, 13/24 were probable and 2/24 patients were proven IMI. In 94/128 patients with antifungal therapy, serum GM-testing was conducted. In 10/94 patients, GM testing was positive. Nine of these ten cases were probable IA, whilst one of the cases was proven IMI with the mould Geosmithia argillacea. Conclusion Compared to a previous study at the same institution, it was possible to establish, because of the GM testing, a significantly higher number of probable and proven IFI. This special diagnostic tool enabled a more exact classification of probable IFI according to the EORTC/MSG criteria