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Effect of fluconazole prophylaxis on the incidence of invasive candida infections and bacteraemias in patients with acute leukaemia
Article first published online: 23 JAN 2008
DOI: 10.1111/j.1600-0609.2008.01041.x
© 2008 The Authors
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How to Cite
Nihtinen, A., Anttila, V.-J., Elonen, E., Juvonen, E., Volin, L. and Ruutu, T. (2008), Effect of fluconazole prophylaxis on the incidence of invasive candida infections and bacteraemias in patients with acute leukaemia. European Journal of Haematology, 80: 391–396. doi: 10.1111/j.1600-0609.2008.01041.x
Publication History
- Issue published online: 23 JAN 2008
- Article first published online: 23 JAN 2008
- Accepted for publication 9 January 2008
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Keywords:
- candida infections;
- leukaemia;
- fluconazole prophylaxis
Abstract
Objectives: The efficacy of fluconazole prophylaxis to prevent invasive candida infections in patients with acute leukaemia receiving chemotherapy is not clear. Fluconazole prophylaxis might increase the number of bacteraemias and cause outbreaks of non-albicans yeast infections. A retrospective single-centre study was conducted to investigate the effect of fluconazole prophylaxis on the incidence and the species of invasive candida infections and on the number of bacteraemias.
Methods: All 1089 adult acute leukaemia patients treated with chemotherapy in 1978–2004 at Helsinki University Central Hospital were included. Data of positive blood cultures, histological samples, and fungal cultures was collected from the patient charts and the microbiology laboratory database. Fluconazole prophylaxis was used in all patients from 2000 on.
Results: Invasive candida infection was diagnosed in 74 out of 847 patients (8.7%) treated without fluconazole prophylaxis and in four out of 242 patients (1.6%) receiving the prophylaxis (P < 0.001). The incidence of non-albicans infections did not increase in the fluconazole prophylaxis group. A larger proportion of patients developed bacteraemias in the prophylaxis group (65%) compared to the non-prophylaxis group (52%) (P < 0.001). A trend towards more gram-positive bacteraemias was seen in the prophylaxis group. Invasive candida infections were more common in patients with acute lymphoblastic leukaemia than those with acute myeloid leukaemia, 10.5% vs. 5.9% (P = 0.008).
Conclusions: Fluconazole prophylaxis was effective in preventing invasive candida infections in patients with acute leukaemia without increasing non-albicans infections. The risk of bacteraemias, however, increased