Breakthrough Mycosis in Patients with Hematological Malignancies Receiving Posaconazole Prophylaxis

Y-S. Huang, H-Y. Sun, S-W. Lin, Y-C. Chen, S-C. Chang

Author address: 

Natl. Taiwan Univ. Hosp., Taipei, TAIWAN

Abstract: 

Background: Posaconaszole, a broad-spectrum triazole, demonstrates promising results in preventing and treating invasive fungal infections (IFIs) in severely immunocompromised patients. However, there are concerns whether its wide use as prophylaxis would change the epidemiology of IFIs. A shift to non-Aspergillus spp., in particular to mucormycetes has been reported (Auberger J, et al. JAC 2012). Thus, the present study aimed to assess the IFI developing under posaconazole prophylaxis and its effectiveness as salvage therapy. Methods: Between December 2010 and January 2013, 31 patients with hematological malignancies receiving posaconazole consecutively at our institute were retrospectively evaluated; 23 of them received posaconazole as prophylaxis during their neutropenia after chemotherapy/peripheral blood stem cell transplantation. The remaining 8 patients received posaconazole as salvage therapy after the first-line agent failed. Breakthrough IFIs, patient outcomes, and adverse event were analyzed. IFI was diagnosed per EORTC/MSG criteria. Results: Among 23 patients who took 35 courses of posaconazole in prophylaxis group, 4 episodes (11.4%) of IFI were documented, including septic arthritis caused byColletotrichum coccodes in 1, and pulmonary invasive aspergillosis in 3. Ten of them died eventually, including all 4 patients with IFI. Among the 8 patients receiving posaconazole as salvage therapy, their IFI included mucormycosis in 3 (pulmonary, brain abscess and liver abscess caused by Cunninghamella species), aspergillosis (infective endocarditis; invasive pulmonary aspergillosis) in 4, hepatosplenic abscess caused by C. tropicalis in 1. Four of these 8 patients with IFI died of uncontrolled infection, 1 discontinued the drug due to side effect, and the remaining 3 patients continued posaconazole when the study ended. Few adverse events were observed. Two of the 23 patients discontinued the drug owing to hyperbilirubinemia and musculoskeletal pain respectively. Conclusions: Due to small case number, we did not observe a shift to non- Aspergillus spp. in patients receiving posaconazole prophylaxis, but the development of rare IFI was observed. In the present study, posaconazole showed modest effectiveness as salvage therapy.
2013

abstract No: 

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Full conference title: 

53rd Interscience Conference on Antimicrobial Agents and Chemotherapy
    • ICAAC, 53rd (2013)