title: Primary antifungal prophylaxis with micafungin in patients with haematological malignancies: real-life data from a retrospective single-centre observational study.
abstract: Mould-active antifungal prophylaxis is increasingly used in patients at risk for invasive fungal disease. Between June 2011 and June 2012, one hundred patients with various haematological malignancies at risk for invasive fungal disease received primary antifungal prophylaxis with intravenous micafungin at a daily dosage of 50 mg during neutropenia. The median number of days on micafungin prophylaxis was 14 (range, 6-48 d). The incidence of proven and probable breakthrough invasive fungal diseases (bIFDs) was 6% and 3%, respectively. There were two bloodstream infections caused by yeasts or yeast-like fungi (Candida krusei, Trichosporon asahii) in two patients during the neutropenic phase after allogeneic haematopoietic stem cell transplantation. Four proven bIFDs caused by non-Aspergillus moulds and three cases of probable pulmonary bIFDs were documented during the neutropenic phase after induction/consolidation chemotherapy for acute leukaemia. Colonisation with Candida spp. was documented in 51% of the patients with none of the isolates being in vitro micafungin resistant. Compared to a historical control, receiving primary prophylaxis with posaconazole micafungin is at least as effective in preventing IFD. In both cohorts, bIFDs were exclusively caused by emerging pathogens with a highly preserved in vitro sensitivity to amphotericin B.
authors.affiliation: Haematology & Oncology, University Hospital of Internal Medicine V, Innsbruck, Austria.
authors.forename: David
authors.initials: D
authors.lastname: Nachbaur
authors.forename: Olga
authors.initials: O
authors.lastname: Angelova
authors.forename: Dorothea
authors.initials: D
authors.lastname: Orth-Höller
authors.forename: Adelheid
authors.initials: A
authors.lastname: Ditlbacher
authors.forename: Michaela
authors.initials: M
authors.lastname: Lackner
authors.forename: Jutta
authors.initials: J
authors.lastname: Auberger
authors.forename: Cornelia
authors.initials: C
authors.lastname: Lass-Flörl
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000150:complications / Q000382:microbiology / Q000473:pathology / Q000517:prevention & control*; D004334:Drug Administration Schedule; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000382:microbiology / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007275:Injections, Intravenous; D055666:Lipopeptides / Q000627:therapeutic use; D008297:Male; D000077551:Micafungin; D008875:Middle Aged; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D014230:Triazoles / Q000627:therapeutic use; D014250:Trichosporon / Q000302:isolation & purification; D060586:Trichosporonosis / Q000150:complications / Q000382:microbiology / Q000473:pathology / Q000517:prevention & control*
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D014230:Triazoles; C101425:posaconazole; D000666:Amphotericin B; D000077551:Micafungin
keywords: colonisation; invasive aspergillosis; leukaemia; micafungin; non-Aspergillus moulds; prophylaxis