Breakthrough invasive fungal diseases during echinocandin treatment in high-risk hospitalized hematologic patients.
The frequency of breakthrough invasive fungal diseases (IFDs) during echinocandin therapy is unclear. We retrospectively analyzed 534 hematologic patients treated with echinocandin (caspofungin, N = 55; micafungin, N = 306; anidulafungin, N = 173). Four proven IFDs were found, caused by Candida parapsilosis (N = 2), C. parapsilosis and Candida glabrata (N = 1), and Fusarium species (N = 1). Four cases of possible IFDs were observed, all showing pulmonary infection. One case showed features suggestive of hepatosplenic candidiasis. Six of these eight cases had previously received the purine analog clofarabine. Breakthrough IFD during echinocandin treatment occurred infrequently (1.5 %), caused predominantly by Candida species. Clofarabine usage was an important risk factor.
Department of Medicine, Queen Mary Hospital, Professorial Block, Pokfulam Road, Hong Kong, China.
Thomas S Y
TS
Chan
Harinder
H
Gill
Yu-Yan
YY
Hwang
Joycelyn
J
Sim
Alan C T
AC
Tse
Florence
F
Loong
Pek-Lan
PL
Khong
Eric
E
Tse
Anskar Y H
AY
Leung
Chor-Sang
CS
Chim
Albert K W
AK
Lie
Yok-Lam
YL
Kwong
D000227:Adenine Nucleotides / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000077612:Anidulafungin; D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000627:therapeutic use; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects / Q000627:therapeutic use; D001087:Arabinonucleosides / Q000009:adverse effects / Q000627:therapeutic use; D002175:Candida / Q000187:drug effects* / Q000276:immunology / Q000302:isolation & purification; D058365:Candidiasis, Invasive / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D000077336:Caspofungin; D002681:China / Q000453:epidemiology; D000077866:Clofarabine; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control / Q000821:virology; D054714:Echinocandins / Q000627:therapeutic use*; D060585:Fusariosis / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D005670:Fusarium / Q000187:drug effects* / Q000276:immunology / Q000302:isolation & purification; D006402:Hematologic Diseases / Q000150:complications / Q000276:immunology* / Q000628:therapy / Q000821:virology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D016867:Immunocompromised Host; D055666:Lipopeptides / Q000627:therapeutic use*; D008172:Lung Diseases, Fungal / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control / Q000821:virology; D000077551:Micafungin; D012189:Retrospective Studies; D012307:Risk Factors
D000227:Adenine Nucleotides; D000935:Antifungal Agents; D000964:Antimetabolites, Antineoplastic; D001087:Arabinonucleosides; D054714:Echinocandins; D055666:Lipopeptides; D000077866:Clofarabine; D000077612:Anidulafungin; D000077336:Caspofungin; D000077551:Micafungin