Antimold Prophylaxis May Reduce the Risk of Invasive Fusariosis in Hematologic Patients with Superficial Skin Lesions with Positive Culture for Fusarium.
Hematologic patients with superficial skin lesions on admission growing Fusarium spp. are at a high risk for developing invasive fusariosis during neutropenia. We evaluated the impact of primary prophylaxis with a mold-active azole in preventing invasive fusariosis in these patients. Between August 2008 and December 2014, patients with acute leukemia or aplastic anemia and recipients of hematopoietic cell transplants were screened on admission with dermatologic and direct exams and fungal cultures of superficial skin lesions. Until November 2009, no interventions were made. Beginning in December 2009, patients with baseline skin lesions and a direct exam and/or culture suggestive of the presence of Fusarium spp. received prophylaxis with voriconazole or posaconazole. Skin lesions in the extremities (mostly onychomycosis and interdigital intertrigo) were present on admission in 88 of 239 episodes (36.8%); 44 lesions had hyaline septate hyphae identified by direct exam, and cultures from 11 lesions grew Fusarium spp. Antimold prophylaxis was given for 20 episodes (voriconazole for 17 and posaconazole for 3). Invasive fusariosis was diagnosed in 14 episodes (5.8%). Among patients with baseline skin lesions with positive cultures for Fusarium spp., 4 of 5 without antimold prophylaxis developed invasive fusariosis versus 0 of 6 with antimold prophylaxis (P = 0.01; 95% confidence interval for the difference between proportions, 22% to 96%). Primary antifungal prophylaxis with an antimold azole may prevent the occurrence of invasive fusariosis in high-risk hematologic patients with superficial skin lesions on admission growing Fusarium spp.
University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Andrea G
AG
Varon
University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Simone A
SA
Nouér
University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Gloria
G
Barreiros
University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Beatriz Moritz
BM
Trope
University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Tiyomi
T
Akiti
University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil mnucci@hucff.ufrj.br.
Marcio
M
Nucci
D000293:Adolescent; D000328:Adult; D000368:Aged; D000741:Anemia, Aplastic / Q000382:microbiology; D000935:Antifungal Agents / Q000627:therapeutic use*; D005260:Female; D060585:Fusariosis / Q000188:drug therapy* / Q000517:prevention & control*; D005670:Fusarium / Q000187:drug effects*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D016867:Immunocompromised Host; D007402:Intertrigo / Q000188:drug therapy; D007938:Leukemia / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D014009:Onychomycosis / Q000188:drug therapy; D011446:Prospective Studies; D012867:Skin / Q000382:microbiology; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole / Q000627:therapeutic use*; D055815:Young Adult
D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole; D065819:Voriconazole
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