title: Effect of fluconazole prophylaxis on the incidence of invasive candida infections and bacteraemias in patients with acute leukaemia.
abstract: OBJECTIVE
  The efficacy of fluconazole prophylaxis to prevent invasive candida infections in patients with acute leukaemia receiving chemotherapy is not clear. Fluconazole prophylaxis might increase the number of bacteraemias and cause outbreaks of non-albicans yeast infections. A retrospective single-centre study was conducted to investigate the effect of fluconazole prophylaxis on the incidence and the species of invasive candida infections and on the number of bacteraemias.
  
  
  METHODS
  All 1089 adult acute leukaemia patients treated with chemotherapy in 1978-2004 at Helsinki University Central Hospital were included. Data of positive blood cultures, histological samples, and fungal cultures was collected from the patient charts and the microbiology laboratory database. Fluconazole prophylaxis was used in all patients from 2000 on.
  
  
  RESULTS
  Invasive candida infection was diagnosed in 74 out of 847 patients (8.7%) treated without fluconazole prophylaxis and in four out of 242 patients (1.6%) receiving the prophylaxis (P < 0.001). The incidence of non-albicans infections did not increase in the fluconazole prophylaxis group. A larger proportion of patients developed bacteraemias in the prophylaxis group (65%) compared to the non-prophylaxis group (52%) (P < 0.001). A trend towards more gram-positive bacteraemias was seen in the prophylaxis group. Invasive candida infections were more common in patients with acute lymphoblastic leukaemia than those with acute myeloid leukaemia, 10.5% vs. 5.9% (P = 0.008).
  
  
  CONCLUSIONS
  Fluconazole prophylaxis was effective in preventing invasive candida infections in patients with acute leukaemia without increasing non-albicans infections. The risk of bacteraemias, however, increased.
authors.affiliation: Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. anne.nihtinen@hus.fi
authors.forename: Anne
authors.initials: A
authors.lastname: Nihtinen
authors.forename: Veli-Jukka
authors.initials: VJ
authors.lastname: Anttila
authors.forename: Erkki
authors.initials: E
authors.lastname: Elonen
authors.forename: Eeva
authors.initials: E
authors.lastname: Juvonen
authors.forename: Liisa
authors.initials: L
authors.lastname: Volin
authors.forename: Tapani
authors.initials: T
authors.lastname: Ruutu
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control*; D002177:Candidiasis / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D015725:Fluconazole / Q000494:pharmacology*; D006801:Humans; D007938:Leukemia / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D015725:Fluconazole