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Post-Transplant Events

Empirical antifungal therapy in selected patients with persistent febrile neutropenia

Bone Marrow Transplantation volume 45, pages 159–164 (2010)Cite this article

Abstract

Universal empirical antifungal therapy (EAT) in patients with unexplained persistent febrile neutropenia (PFN) is the standard of care, but EAT could be applied in selected patients on the basis of clinical criteria and risk factors. A prospective interventional study was carried out to analyse the incidence and related mortality of invasive fungal infection (IFI) in patients with PFN according to whether or not EAT was indicated. EAT was indicated according to the following criteria: (a) severe sepsis or septic shock; (b) focused infection: lung, central nervous system, sinus, abdominal or skin; (c) individualized clinical decision in patients at high risk. Sixty-six (19%) of 347 episodes of febrile neutropenia fulfilled PFN criteria, 97% with a haematological malignancy. Just 26 (39.4%) were treated with EAT. The overall IFI incidence was 4.5%. In the group that received EAT, three patients developed IFI (11.5%), in comparison with none in the group that did not receive it (P=0.04, RR 2.7:1.9–3.8). IFI-related mortality was null in the group that did not receive EAT and 8% (two of 26 patients) in the group that received EAT. These data suggest that in patients with PFN, EAT in selected patients may be safe and avoid unnecessary antifungal therapy.

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Acknowledgements

We thank Ms Elaine Larson for assistance with English syntax. This work was supported by Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, Spanish Network of Infection in Transplantation (RESITRA G03/075) and Spanish Network for the Research in Infectious Diseases (REIPI RD06/0008).

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Authors and Affiliations

  1. Infectious Disease Service, Virgen del Rocio University Hospital, Seville, Spain

    M Aguilar-Guisado, E Cordero, J Pachón & J M Cisneros

  2. Hematology Service, Virgen del Rocio University Hospital, Seville, Spain

    I Espigado & R Parody

  3. Oncology Service, Virgen del Rocio University Hospital, Seville, Spain

    M Noguer

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  1. M Aguilar-Guisado
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  2. I Espigado
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  6. J Pachón
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  7. J M Cisneros
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Correspondence to M Aguilar-Guisado.

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Aguilar-Guisado, M., Espigado, I., Cordero, E. et al. Empirical antifungal therapy in selected patients with persistent febrile neutropenia. Bone Marrow Transplant 45, 159–164 (2010). https://doi.org/10.1038/bmt.2009.125

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