A survey of practice relating to the prevention and treatment of invasive fungal infections in UK transplant centres

Ref ID: 18619

Author:

N. Duncan, C. Craddock, M. Cook on behalf of the UK BMT
Pharmacists’ Group

Author address:

NULL

Full conference title:

Annual Meeting of the EBMT, 37th

Abstract:

Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in patients with haematological malignancies.
Although guidelines exist for the management of IFIs in this
patient group, practice has been shown to vary widely between
European haematology centres. The aim of the current study
was to investigate whether similar variability exists in the United
Kingdom or whether recently published guidelines have helped
to standardise practice.
A short questionnaire was sent electronically to all members of
the UKBMT pharmacists’ group. Questions focused on prophylaxis and treatment of fungal infection in three specifi c clinical
areas – AML induction, autologous stem cell transplantation
(SCT) and allogeneic SCT.
Responses were received from 29 centres. All centres treated
autologous SCT and AML patients and 27 treated allogeneic
SCT patients. Itraconazole and fl uconazole were the most
widely used prophylactic agents although only 72% of centres
gave prophylaxis to all three patients groups. Variability existed
between patient groups with fl uconazole (dose range 50-400 mg/
day) being most widely used in patients undergoing Autologous SCT (42% of centres) but itraconazole being preferred in
the settings of both allogeneic SCT (56%) and AML induction
(60%). Four centres (14%) gave posaconazole prophylaxis during AML induction. Empirical therapy was recommended by 22
centres (76%). Ambisome®
(dose range 1-3 mg/kg/day) was the
most widely used empirical antifungal agent and it was also the
fi rst line drug for the management of invasive aspergillosis in
50% of antifungal policies. Voriconazole and caspofungin were
recommended as the fi rst line antifungal agent in 23% and 20%
of policies respectively. Other fi rst line agents were Abelcet®
(7%) and posaconazole (3%). No centres used conventional
amphotericin B. Caspofungin was the most popular second line
agent, being recommended in 40% of policies, followed by voriconazole (30%) and Ambisome (25%). Twenty centres (69%)
would consider giving dual therapy, with combinations of lipid
amphotericin plus caspofungin (37%) and lipid amphotericin
plus voriconazole (37%) being most commonly recommended.
Similar to an earlier Europe-wide survey, this study showed
signifi cant variations in practice between UK haematology centres with respect to both preventing and treating invasive fungal
infections. Recent guidelines in this area do not appear to have
resulted in a standardisation of practice.

Abstract Number: P781

Conference Year: 2011

Link to conference website: NULL

New link: NULL

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