Incidence and management of proven and probable fungal infections in patients with acute leukemia: a single center experience.
The incidence of fungal infections and the role of liposomal amphotericin B (Ambisome) in proven and probable infections were evaluated in acute leukemic patients, intolerant to conventional amphotericin B. During 1999-2002, 307 febrile episodes occurred in 231 patients. Fungi were responsible for 3% of bloodstream infections. Ambisome was employed in 5 fungal sepsis (1 Candida albicans, 1 C. famata, 1 C. tropicalis, 1 C. krusei, 1 Geotrichum capitatum) 2 Aspergillosis, 2 probable fungal pneumonia cases. A favorable response was achieved in 78% of patients (4 fungemia, 2 aspergillosis, 1 probable), an unfavorable response in 1 C. krusei fungemia and in 1 probable pneumonia. Our antimicrobial pattern documented a high resistance rate to azoles. We concluded that Ambisome is an effective and well tolerated agent and its introduction has changed the outcome for many patients, although in some refractory diseases other strategies must be considered.
Fanci
R
R
Department of Hematology and University of Florence, Careggi Hospital, Florence, Italy. r.fanci@dac.unifi.it
Casini
C
C
Leoni
F
F
Ciolli
S
S
Bosi
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D025141:Drug Resistance, Fungal; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000382:microbiology*; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000382:microbiology*; D012307:Risk Factors; D016896:Treatment Outcome
D000935:Antifungal Agents; D008081:Liposomes; C068538:liposomal amphotericin B; D000666:Amphotericin B