Article

Prevention and early treatment of invasive fungal infection in patients with cancer and neutropenia and in stem cell transplant recipients in the era of newer broad-spectrum antifungal agents and diagnostic adjuncts.

Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
Clinical Infectious Diseases (impact factor: 9.15). 03/2007; 44(3):402-9. DOI:10.1086/510677 pp.402-9
Source: PubMed

ABSTRACT Invasive fungal infection (IFI) is a leading cause of infection-related mortality among patients with cancer and prolonged neutropenia and among allogeneic hematopoietic stem cell transplant recipients with graft-versus-host disease. Invasive candidiasis was the principal IFI in the period predating fluconazole prophylaxis, whereas today, invasive aspergillosis and other mold infections cause the majority of deaths from fungal infection in this patient population. The changing epidemiology of IFI, in addition to advances made in antifungal therapeutics and early diagnosis of IFI, warrant a reevaluation of earlier strategies aimed at prevention and early treatment of IFI that were developed several years ago. Here, we propose that persistent neutropenic fever is nonspecific for an IFI and should not be used as the sole criterion for empirical modification in the antifungal regimen in a patient receiving mold-active prophylaxis. We explore the potential benefits and gaps in knowledge associated with employing chest CT scans and laboratory markers as diagnostic adjuncts for IFI. Finally, we discuss the implications of newer antifungal agents and diagnostic adjuncts in the design of future clinical trials to evaluate prophylaxis and early prevention strategies.

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Keywords

allogeneic hematopoietic
 
antifungal regimen
 
antifungal therapeutics
 
cell transplant recipients
 
chest CT scans
 
diagnostic adjuncts
 
empirical modification
 
future clinical trials
 
infection-related mortality
 
Invasive candidiasis
 
Invasive fungal infection
 
laboratory markers
 
mold infections cause
 
mold-active prophylaxis
 
newer antifungal agents
 
patient population
 
period predating fluconazole prophylaxis
 
persistent neutropenic fever
 
potential benefits
 
principal IFI
 

Brahm H Segal