657. Single Agent Versus Multiple Agent Antifungal Therapy in Fusarium Infection: Ten Year Experience in a Neutropenic Patient Population
Session: Abstracts: Mycology
Friday, October 22, 2010
Background:

Invasive fungal infections (IFI), specifically disseminated Fusarium infection (FI), are historically associated with high mortality in immunocompromised patients (IP) and treatment with single agent antifungal therapy (SAAFT) or multiple agent antifungal therapy (MAAFT) is reasonable.  Further investigation is required to detemine the superiority of either SAAFT or MAAFT in this setting.

Methods:

From 1999-2009 data was collected on all documented FI.  57 patients were identified and data pursuant to basic demographics, malignancy, neutropenia, and clinical measures were collected.  The primary objective was to assess overall survival comparing SAAFT to MAAFT for FI in a neutropenic population.

Results:

From 1999-2009 data was collected on all documented FI.  57 patients were documented and efficacy was assessed through a primary endpoint of death from any cause.  Of the 57 patients, 18 were excluded for insufficient data regarding therapy.  The remaining 39 patients were divided regarding outcomes: 15 (38.4%) died during admission, 11 (28.2%) went home with hospice, 13 (33.3%) are currently alive.  Overall, 16 (41%) patients were treated with SAAFT: voriconazole (V), n = 7, 43.7%; ambisome (Amb), n = 4, 25%; itraconazole n = 2, 12.5%; abelcet, n = 1, 6.2%; micafungin (M), n = 1, 6.2%; and fluconazole, n = 1, 6.2%.  Outcomes for SAAFT group were: 4 (25%) death, 3 (18.8%) home with hospice, 9 (56.2%) alive.  23 (59%) patients received MAAFT, the most common combinations being V-Amb (n = 8, 30.4%) and V-M (n = 4, 17.3%).  In most cases, patients were switched from SAAFT to MAAFT immediately following isolation of FI.  Outcomes for the MAAFT group were: 11 (47.9%) death, 8 (34.7%) home with hospice, and 4 (17.4%) alive.  Median duration of neutropenia at the time of diagnosis was 32 days (range 10-390 days) overall with 42 days in the MAAFT group and 30 days in the SAAFT group. 

Conclusion:

Our data did not demonstrate superiority of MAAFT over SAAFT for the treatment of FI in IP.  Additionally, our data did not demonstrate  a difference in outcome as death rates were similar from 1999-2005 (n = 6) to 2006-2009 (n = 9) with the availability of posaconazole or V.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Rebecca L. Tombleson, PharmD , Pharmacy, Moffitt Cancer Center, Tampa, FL
Deepti S. Canchi, MD , Infectious Diseases, Moffitt Cancer Center, Tampa, FL
John Greene, MD , Infectious Disease, Moffitt Cancer Center, Tampa, FL
Rod E. Quilitz, PharmD , Pharmacy, Moffitt Cancer Center, Tampa, FL

Disclosures:

R. L. Tombleson, None

D. S. Canchi, None

J. Greene, None

R. E. Quilitz, None

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