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430
Patients with Prolonged (>10 days) Neutropenia Displayed Similar IFI Rates Regardless of Hematologic Diagnosis and Chemotherapy Status: A Challenge to Antifungal Prophylaxis Decisions

Session: Poster Abstract Session: Transplant Infectious Diseases
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • IDSA2014 - IFI in Neutropenic Patientsposter.pdf (201.7 kB)
  • Background: Invasive fungal infections (IFI) are a significant source of morbidity and mortality in neutropenic patients. Risk based prophylaxis or pre-emptive therapy are debated clinical approaches. Since 2009, IPC at our tertiary care institution has collected the IFI rate per 1000 neutropenic patient days. We examine IFI per neutropenic episode by patient characterictics and duration of neutropenia.

    Methods: all neutropenic Hematology ward patients were assessed, those with ANC of 0.5 x 109/L or less for >10 days were followed prospectively for development of Probable or Definite IFI by the 2008 EORTC criteria. Chart data were collected: demographics, hematologic diagnosis, type of chemotherapeutic regimen, and neutropenic days (NDS), and if an IFI was diagnosed; the fungus, site of culture, and outcome . 

    Results: There were 277 neutropenic episodes in 180 patients, (mean 26 NDs) identified from Jan 2009 to December 2010.  ‘Severe’ criteria was met in 177 episodes (63.9%) in 116 patients (mean 37.8 NDs). Twenty (17.2%) of these had IFI with 6 (30%) related deaths. 

    Hematologic Diagnosis

    Chemotherapy

    Mean Neutropenic Days (range)

    IFI per episode of severe neutropenia (%)

    Comment:

    The “Other” category included aplastic anemia, CLL, CML, lymphoma, HLH, and palliative end stage marrow failure

    AML (n=70)

    Induction

    28.6 (10-88)

    7/70 (10.0)

    Consolidation

    21.9 (10-84)

    2/19 (10.5)

    Re-Induction

    38.8 (11-155)

    3/19 (15.7%)

    Myelodysplasia (n=15)

    n/a

    68 (10-420)

    2/15 (13.3%)

    ALL (n=14)

    Induction

    14.6 (11-16)

    0/7

    Re-induction

    26 (11-41)

    2/7

    Other (n=44)

    n/a

    52.8 (10-870)

    6/44 (13.6%)

    IFI case patients (21 IFIs) had a mean of 43.9 NDs per episode (4-148 days) . There were 6 cases of aspergillosis, 14 candidiasis, and 1 fungus that failed to grow but resembled coccidiomycosis.

    Conclusion: The range of NDs per episode was broader than expected.  In all but ALL patients the IFI rate was 10-16% of neutropenic episodes.   Our current criteria for antimould prophylaxis (re/induction AML) would have applied to 10 IFI in 89 episodes, with 10 IFI in 69 episodes (all other non ALL patients) planned for prophylaxis under our current rules.   Larger studies of the intensity and modifiability of IFI risk in nonacute hematologic diagnoses are needed.

    Lynora Saxinger, MD, FRCPC, Division of Infectious Diseases, University of Alberta, Edmonton, AB, Canada and Aliyah Pabani, MD, Internal Medicine, University of Alberta, Edmonton, AB, Canada

    Disclosures:

    L. Saxinger, None

    A. Pabani, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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