title: Efficacy of anti-fungal but not anti-bacterial prophylaxis in intensive primary AML therapy: a real-world, retrospective comparative single-centre study.
abstract: OBJECTIVE
  The optimal strategy of anti-infectious prophylaxis in patients with acute leukaemia undergoing intensive chemotherapy remains a matter of debate. We assessed the impact of primary prophylaxis with posaconazole and levofloxacin on the incidence of invasive fungal infections (IFI) and bacteraemia.
  
  
  METHODS
  A retrospective single-centre study including two groups of adult patients with AML receiving intensive chemotherapy. Group one without anti-infective prophylaxis (September 2008 - February 2010), and group two with anti-infective prophyalaxis (March 2010 - April 2011). The primary end-point was IFI according to the EORTC/MSG 2008 definitions and bacteraemia.
  
  
  RESULTS
  Baseline characteristics were similar in the non-prophylaxis (n = 43 patients; 99 chemotherapy cycles) and the prophylaxis (n = 45; 104 chemotherapy cycles) group. IFI were significantly reduced in the prophylaxis group (55.3% vs. 88.9%; p = 0.0032) and there was a trend of the projected IFI-free survival at 100 days to be increased (50.1% vs. 25%; p = 0.0526). One-hundred day overall survival (84.4% and 88.4%, p = 0.35) and 2-year overall survival (64.4% and 58.1%; p = 0.64) were unaffected. No difference in the occurrence of bacteraemia was observed (32.3% vs. 34.6%; p = 0.8). A total of two (3.6%) patients in the non-prophylaxis and three (6.7%) in the prophylaxis group died due to IFI, and two (3.6%) in the non-prophylaxis and none in the prophylaxis group patients had to stop leukaemia treatment due to IFI.
  
  
  CONCLUSIONS
  The anti-infective prophylaxis with posaconazole and levofloxacin resulted in a significant reduction of 'possible' IFI with a number-needed to treat to prevent one IFI of only 3 but did not result in a reduction of the incidence of bacteraemia.
authors: Division of Hematology, University Hospital Zurich, Switzerland; bernhard.gerber@usz.ch.
authors: Bernhard
authors: B
authors: Gerber
authors: Division of Hematology, University Hospital Zurich, Switzerland.
authors: Jan
authors: J
authors: Köppel
authors: Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Switzerland.
authors: Michaela
authors: M
authors: Paul
authors: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland.
authors: Thi Dan Linh
authors: TD
authors: Nguyen-Kim
authors: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland.
authors: Thomas
authors: T
authors: Frauenfelder
authors: Division of Hematology, University Hospital Zurich, Switzerland.
authors: Gayathri
authors: G
authors: Nair
authors: Division of Hematology, University Hospital Zurich, Switzerland.
authors: Urs
authors: U
authors: Schanz
authors: Division of Hematology, University Hospital Zurich, Switzerland.
authors: Markus G
authors: MG
authors: Manz
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D000935:Antifungal Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000517:prevention & control; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D064704:Levofloxacin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000517:prevention & control; D012189:Retrospective Studies; D015996:Survival Rate; D014230:Triazoles / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000970:Antineoplastic Agents; D014230:Triazoles; D064704:Levofloxacin; C101425:posaconazole