Objectives: To assess incidence and risk factors of breakthrough mycosis under micafungin prophylaxis for hematopoietic stem cell transplantation (HSCT). Methods: A total of 50 HSCT recipients receiving micafungin as prophylaxis in 2010-2011 were analyzed. Patients were followed for 100 days post-transplantation for the development of mycosis defined by EORTC. Results: Of the 50 patients, 38% received HSCT for lymphoma, 18% for AML, 14% for ALL, and 14% for MDS; 40% received allogenetic and 36% autologous HSCT. Breakthrough mycosis developed in 4 (8%) patients, including probable aspergillosis in 3 and definite trichosporosis in 1, after a median of 6 days post-transplant and after micafungin use for a median of 16 days. Of the three patients with probable aspergillosis, persistent elevation of aspergillus antigen levels and newly developed pulmonary nodules were the most common presentations. The case with trichosporosis developed fever and disseminated papular rash, and Trichosporon species was isolated from the blood. All these four patients were successfully treated with voriconazole. Compared with 46 patients without breakthrough mycosis, positive cases were more like to be older (mean, 53 vs. 43 years old, p 0.05). All patients had surveillance nasal and throat fungal cultures post-transplant, and 10 patients had positive results, including C. albican in seven patients, C. glabrata in 1, unidentified Candida species in 1, Trichosporon species in 1, and Mycelium sterile in 1. Conclusion: The incidence of breakthrough mycosis during micafungin prophylaxis for HSCT was 8%. Although micafungin had anti-Aspergillus attribute, aspergillosis was the most common breakthrough mycosis.
Full conference title:
22nd European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 22nd (2012)