1335. Fluconazole or Posaconazole in Antifungal prophylaxis in Patients with High-Risk Hematological Malignity?
Session: Poster Abstract Session: Clinical Trials
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDW poster.pdf (116.0 kB)
  • Background: This study was performed in order to compare the effectiveness in prophylaxis of fluconazole (FZ) and posaconozole (PZ) in patients with high-risk febrile neutropenia (FEN) administered antifungal prophylaxis for fungal infection and monitored with a diagnosis of hematological malignity by our hospital hematology clinic. 

    Methods: At risk classification of patients with hematological malignity, patients with profound neutropenia lasting more than one week were regarded as high risk. High-risk patients in 2011 were administered FZ prophylaxis, while in 2012 PZ prophylaxis was administered by consensus decision of the infectious diseases and hematology clinic. This study retrospectively examined these cases monitored with a diagnosis of FEN and was planned to compare the effectiveness of the two drugs in antifungal prophylaxis.

    Results: FZ prophylaxis was administered to 70 patients in 2011. Localized candida infection was identified in seven of these, and rhinocerebral mucormycosis in one. Invasive pulmonary aspergillosis (IPA) was diagnosed in 30 cases,17 probable and 13 possible. PZ prophylaxis was administered to 49 patients in 2012. Fungal infections developing with Candida krusei, Candida norvogensis and Trichosporon beigeii strains were encountered in three patients receiving prophylaxis. IPA developed in 13 patients, nine probable and fourpossible. Incidence of fungal infections in all patients receiving FZ prophylaxis was 38/70 (54%), compared to 16/49 (33%) in patients receiving PZ. The difference was significantly lower in favor of patients receiving PZ prophylaxis (p<0.05). A similar situation applies in terms of IPA. Incidence of IPA in patients receiving FZ was 30/70 (43%), and 13/49 (26.5%) in those receiving PZ (p<0.05). Crude mortality rates were found as 24% and 8% in FZ and PZ arms respectively (p=0.043, OR=3.6, CI=1.04-13.76).

    Conclusion: The subject of which agentshould be selected for prophylaxis in this high-risk patient group is a matter for debate in the literature, and studies exist recommending the use of both drugs. Our study shows that PZ is significantly more effective than FZ in both yeast and mold fungal infections.

    Selçuk Kaya, Asisstant Professor1, Iftihar Köksal, Professor1, Eda Gençalioglu1, Mehmet Sönmez, Professor2, Mustafa Yılmaz, Associate Professor2 and Gürdal Yılmaz, Associate Professor1, (1)Infectious Diseases and Clinical Microbiology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey, (2)Hematology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey

    Disclosures:

    S. Kaya, None

    I. Köksal, None

    E. Gençalioglu, None

    M. Sönmez, None

    M. Yılmaz, None

    G. Yılmaz, None

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