Reduction in incidence of invasive aspergillosis (IA) among hematopoeitic stem cell transplant (HSCT) patients receiving voriconazole (VORI) prophylaxis: 2 year experience at a large teaching hospital

Siwek G 1,2,4, Diekema D 1,2,4, Polgreen P 1,2, Magalheas-Silverman M 1,3, Hoth P 1,3, Pfaller M 1,4,5

Author address: 

1 University of Iowa, 2 Division of Infectious Diseases, 3 Division of Hematology Oncology, 4 Division of Medical Microbiology, 5 Department of Epidemiology

Abstract: 

Background: HSCT patients are at risk for invasive fungal infections, including IA and invasive candidiasis. Currently the IDSA recommends prophylaxis with fluconazole, which is active against most Candida species but has no activity against Aspergillus. Voriconazole is well tolerated and has excellent activity against both Candida and Aspergillus. While many institutions have begun using VORI for prophylaxis in HSCT patients, little data exist to support this practice. Methods: We performed a retrospective observational study to describe the incidence of IA and other invasive fungal infections in HSCT patients at the University of Iowa from 1998-2005. We reviewed microbiologic, radiographic, and histologic records on all patients and used established criteria for identifying definite or probable IA. From 1998 through 2002, amphotericin B or itraconazole were the most commonly used agents for prophylaxis of HSCT patients. Beginning in 2002, most allogeneic HSCT patients routinely received VORI prophylaxis from day 0 through day 100. In patients with GVHD, VORI use continued while immunosuppression was required. VORI was given at a dose of 200 mg PO BID unless drug interactions mandated a different dose. Results: 314 allogeneic HSCT patients were evaluated. Of the 95 patients transplanted after 2002, 92 received at least 1 week of VORI. None of these 92 patients met criteria for definite or probable IA or had a positive culture for Aspergillus. Of the 51 patients in this group who died, 23 had autopsies, and none demonstrated evidence of IA. Of the 219 patients transplanted prior to routine VORI prophylaxis, 23 (11%) met criteria for definite or probable IA. The difference in incidence of IA among these 219 patients compared with those receiving VORI prophylaxis (0/92) was statistically significant (p
2005

abstract No: 

5

Full conference title: 

15th Annual Focus on Fungal Infections
    • FFI 15th (2005)