Management of infection in patients with acute leukemia during chemotherapy in Japan: questionnaire analysis by the Japan Adult Leukemia Study Group.
Guidelines for the management of febrile neutropenia (FN), deep fungal infection or use of granulocyte colony-stimulating factor (G-CSF) published in the US and Europe cannot be directly applied in other countries. In this study, we undertook a questionnaire survey of member institutions of the Japan Adult Leukemia Study Group to investigate the status of, and problems with, the management of infectious complications in patients with acute leukemia. The questionnaire consisted of 52 multiple-choice questions covering therapeutic environment, antibacterial, and antifungal prophylaxis, empirical therapy (ET) for FN, and use of G-CSF. The results were compared to a previous survey performed in 2001. Usable responses were received from 134 of 184 (71.7%) institutions. With regard to antibacterial prophylaxis, fluoroquinolones and sulfamethoxazole-trimethoprim were most commonly used. Regarding antifungal prophylaxis, the most frequently used agent was fluconazole, followed by itraconazole. In ET for FN, monotherapy with cephems or carbapenems accounted for almost all of the responses. Most respondents indicated that they used micafungin (MCFG) in ET. Prophylactic use of G-CSF during remission induction therapy in acute myeloid leukemia was reported by only 4% of respondents. Strategies for antibacterial and antifungal prophylaxis or treatment of FN should be reviewed and updated as needed.
Fujita
Hiroyuki
H
Department of Rheumatology/Hematology/Infectious Disease, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan. hfujita@yokohama-cu.ac.jp.|Japan Adult Leukemia Study Group, Hamamatsu, Japan. hfujita@yokohama-cu.ac.jp.
Yoshida
Minoru
M
Japan Adult Leukemia Study Group, Hamamatsu, Japan.
Miura
Katsuhiro
K
Japan Adult Leukemia Study Group, Hamamatsu, Japan.
Sano
Tetsuaki
T
Japan Adult Leukemia Study Group, Hamamatsu, Japan.
Kito
Katsuyuki
K
Japan Adult Leukemia Study Group, Hamamatsu, Japan.
Takahashi
Masatomo
M
Japan Adult Leukemia Study Group, Hamamatsu, Japan.
Shigeno
Kazuyuki
K
Japan Adult Leukemia Study Group, Hamamatsu, Japan.
Kanda
Yoshinobu
Y
Japan Adult Leukemia Study Group, Hamamatsu, Japan.
Akiyama
Nobu
N
Japan Adult Leukemia Study Group, Hamamatsu, Japan.
Hatsumi
Naoko
N
Japan Adult Leukemia Study Group, Hamamatsu, Japan.
Ohnishi
Kazunori
K
Japan Adult Leukemia Study Group, Hamamatsu, Japan.
Miyawaki
Shuichi
S
Japan Adult Leukemia Study Group, Hamamatsu, Japan.
Naoe
Tomoki
T
Japan Adult Leukemia Study Group, Hamamatsu, Japan.
D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005334:Fever / Q000150:complications; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D019538:Health Care Surveys; D006801:Humans; D007564:Japan; D007938:Leukemia / Q000150:complications*; D009181:Mycoses / Q000150:complications / Q000188:drug therapy*; D009503:Neutropenia / Q000150:complications; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D016179:Granulocyte Colony-Stimulating Factor