Invasive aspergillosis in severely neutropenic patients over 18 years: impact of intranasal amphotericin B and HEPA filtration.
The impact of intranasal amphotericin B and high-efficiency particulate air (HEPA) filtration on the incidence of invasive aspergillosis was reviewed in patients from 1977 to 1994 undergoing intensive chemotherapy. Overall, the incidence of proven invasive aspergillosis was reduced from 24.4% (1977-1984) to 7.1% (1985-1991) (P < 0.001) following the introduction of intranasal prophylaxis, but when probable cases of aspergillosis were included and lymphoma cases excluded, there was no change in incidence. Following the introduction of HEPA filtration, patient exposure to aspergillus spores as measured by air sampling was markedly reduced and there were no new cases of invasive aspergillosis. HEPA filtration proved effective in reducing invasive aspergillosis and has allowed increasingly aggressive treatment regimens to be introduced.
Withington
S
S
Department of Infectious Diseases, Christchurch Hospital, New Zealand.
Chambers
S T
ST
Beard
M E
ME
Inder
A
A
Allen
J R
JR
Ikram
R B
RB
Schousboe
M I
MI
Heaton
D C
DC
Spearing
R I
RI
Hart
D N
DN
D000281:Administration, Intranasal; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects; D001228:Aspergillosis / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D003131:Combined Modality Therapy; D004780:Environment, Controlled; D005260:Female; D005374:Filtration; D019337:Hematologic Neoplasms / Q000188:drug therapy; D006757:Hospital Units / Q000458:organization & administration; D006801:Humans; D008297:Male; D009503:Neutropenia / Q000139:chemically induced*; D016896:Treatment Outcome
D000935:Antifungal Agents; D000970:Antineoplastic Agents; D000666:Amphotericin B