Comparison of the In Vitro Activities of Modern Antifungals against Aspergillus Isolates from Cancer Patients

MICHAIL S. LIONAKIS, MD, RUSSELL E. LEWIS, PharmD, WEI LIU, MD, PhD, GERALD P. BODEY, MD, NATHANIEL D. ALBERT, KENNETH V. ROLSTON, MD, ISSAM I. RAAD, MD and DIMITRIOS P. KONTOYIANNIS, ScD,

Author address: 

Univ. of Texas MD Anderson Cancer Ctr., Houston, TX

Abstract: 

Background: Current treatment for invasive aspergillosis (IA) is suboptimal. The development of a standardized antifungal susceptibility testing method for molds (NCCLS microdilution method [M38-A]) has been a major advance. Inin our microbiology laboratory. Demographics, risk factors for candidemia, Candida species, treatment information, and outcome data were collected. Results: 81 pts with candidemia were identified during the study period. Mean age of pts was 51 yrs, 56% were white, 53% were female, and mean APACHE II score was 16.5. Follow-up blood cultures were obtained in 68%. 20 (27%) of 75 pts with candidemia were referred for ID consultation, and these had a lower mortality than pts without consultation (10% vs. 35%, P0.04). CVL were removed in 81% of pts and these pts had a trend toward lower mortality than pts who did not have removal of CVL (25% vs. 40%, P 0.24). Initial AF therapy agreed with IDSA GL in 80% of pts (80% medical pts, 79% surgical pts). Variation from IDSA GL included no AF Rx (5%), use of fluconazole when AmB was indicated (14%), and inappropriate use of lipid AmB (1%). Mortality was higher in pts whose initial AF Rx varied from IDSA GL versus those whose Rx followed IDSA GL (75% vs. 16%, P0.008); the difference was independent of APACHE II score. Conclusions: Management of candidemia at UAB was frequently consistent with IDSA guidelines: CVL were removed in 81% of pts and initial AF therapy agreed with IDSA GL in 80% of pts. Failure to obtain ID consultation and variation of therapy from IDSA GL were associated with higher mortality.
2003

abstract No: 

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Full conference title: 

41st Annual Meeting Infectious Diseases Society of America
    • Infectious Diseases Society of America 41st