학술논문
Evaluation of Empirical and Preemptive Therapy Approaches of Invasive Mold Infections in Patients with Hematologic Malignancy
ORIGINAL ARTICLE
ORIGINAL ARTICLE
Document Type
Periodical
Author
Source
Cerrahpaşa Medical Journal. December 2023, Vol. 47 Issue 3, p253, 6 p.
Subject
Language
English
Abstract
Introduction Hematologic malignancies are neoplasms of myeloid and lymphoid cells, which comprise the most important components of the immune system. Febrile neutropenic infections are frequently observed during the course or [...]
Objective: We aimed to evaluate the diagnostic and therapeutic approaches of invasive mold infections in febrile neutropenic patients. Methods: This retrospective and single-center study includes patients with hematologic malignancy and invasive mold infections. Predictors for 30-day and 1-year mortality were determined. Results: A total of 87 patients were recorded. Of whom, 48 (55.2%) were male and the mean age was 44.56 [+ or -] 15.83. Twenty patients were in the empirical therapy group and 67 were in the preemptive group. Galactomannan positivity rate was found 24.1% (n = 21). The causative agents were detected in 16 patients. In the initial treatment, liposomal amphotericin B (n = 53), voriconazole (n = 27), caspofungin (n = 5), and posaconazole (n = 1) were used. The 30-day mortality rate was 26.4%, while the 1-year mortality rate was 44.8%. The 30-day (45.0% vs. 20.9%, P = .03) and 1-year (65% vs. 38.8%, P = .04) mortality rates were significantly higher in empirical treatment group than in preemptive treatment group. In multivariate analysis, presence of blasts in peripheral blood (P = .04, 95% CI = 1.01-9.38, odds ratio = 3.07) was determined as an independent risk factor for 30-day mortality. No independent risk factor was found for 1-year mortality. Conclusion: As a result, despite the early initiation of empirical treatment, preemptive therapy approach was as effective as empirical approach in the management of invasive mold infections. Therefore, invasive and noninvasive diagnostic methods should be used more frequently to decrease overtreatment. In conclusion, current interdisciplinary approaches are crucial for evidence-based early diagnosis in immunocompromised patients with hematologic malignancies. Keywords: Empirical therapy, hematologic malignancy, invasive mold infections, preemptive therapy
Objective: We aimed to evaluate the diagnostic and therapeutic approaches of invasive mold infections in febrile neutropenic patients. Methods: This retrospective and single-center study includes patients with hematologic malignancy and invasive mold infections. Predictors for 30-day and 1-year mortality were determined. Results: A total of 87 patients were recorded. Of whom, 48 (55.2%) were male and the mean age was 44.56 [+ or -] 15.83. Twenty patients were in the empirical therapy group and 67 were in the preemptive group. Galactomannan positivity rate was found 24.1% (n = 21). The causative agents were detected in 16 patients. In the initial treatment, liposomal amphotericin B (n = 53), voriconazole (n = 27), caspofungin (n = 5), and posaconazole (n = 1) were used. The 30-day mortality rate was 26.4%, while the 1-year mortality rate was 44.8%. The 30-day (45.0% vs. 20.9%, P = .03) and 1-year (65% vs. 38.8%, P = .04) mortality rates were significantly higher in empirical treatment group than in preemptive treatment group. In multivariate analysis, presence of blasts in peripheral blood (P = .04, 95% CI = 1.01-9.38, odds ratio = 3.07) was determined as an independent risk factor for 30-day mortality. No independent risk factor was found for 1-year mortality. Conclusion: As a result, despite the early initiation of empirical treatment, preemptive therapy approach was as effective as empirical approach in the management of invasive mold infections. Therefore, invasive and noninvasive diagnostic methods should be used more frequently to decrease overtreatment. In conclusion, current interdisciplinary approaches are crucial for evidence-based early diagnosis in immunocompromised patients with hematologic malignancies. Keywords: Empirical therapy, hematologic malignancy, invasive mold infections, preemptive therapy