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Weekly use of fluconazole as prophylaxis in haematological patients at risk for invasive candidiasis.

Vuichard D, Weisser M, Orasch C, Frei R, Heim D, Passweg JR, Widmer AF - BMC Infect. Dis. (2014)

Bottom Line: Overall, Candida glabrata was the predominant species with 29% followed by C. albicans and C. krusei (14% each).No significant increment of non-albicans Candida species with decreased fluconazole susceptibility was perceived over this decade.Once weekly administration of 400 mg of fluconazole to prevent candidaemia appears to have no negative impact on the efficacy as a prophylaxis when compared to standard of care (400 mg of fluconazole daily).

View Article: PubMed Central - PubMed

ABSTRACT

Background: The goal was to determine whether one medical centres' unique antifungal prophylactic regimen for patients at high risk for invasive candidiasis because of their haematological malignancies, haematopoietic stem cell transplants, or high-dose chemotherapy might lead ultimately to a higher incidence of infection, to increasing fluconazole resistance, or to a shift in the predominant strain of Candida in invasive fungal episodes.

Methods: Data were collected retrospectively, for a ten-year period from ONKO-KISS surveillance records, and from hospital, medical, and pharmacy records and then evaluated with respect to incidence of fungal infection episodes, emergence of antifungal drug resistance, and predominance of specific Candida strains in isolate cultures. Fisher's exact test and linear regression were used to compare minimum inhibitory concentrations and to compare the incidence of different Candida isolates, respectively.

Results: The incidence of infection remained quite stable over 10 years with a median of 0.67 episodes/1000 bed days. Overall, Candida glabrata was the predominant species with 29% followed by C. albicans and C. krusei (14% each). No significant increment of non-albicans Candida species with decreased fluconazole susceptibility was perceived over this decade.

Conclusions: Once weekly administration of 400 mg of fluconazole to prevent candidaemia appears to have no negative impact on the efficacy as a prophylaxis when compared to standard of care (400 mg of fluconazole daily).

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Related in: MedlinePlus

Antifungal use on RIHU from 2004–2012 in defined daily dosages (DDD) per 100 patient days. * Liposomal and conventional (cholesteryl sulfate complex) amphotericin B.
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Fig3: Antifungal use on RIHU from 2004–2012 in defined daily dosages (DDD) per 100 patient days. * Liposomal and conventional (cholesteryl sulfate complex) amphotericin B.

Mentions: The use of voriconazole over the same time span exceeded the median amphotericin use slightly with 28.8 DDD/100 PD. Caspofungin consumption increased markedly from 3.5 DDD/100 PD in 2004 to 14.1 DDD/100 PD in 2006, but its use changed only minimally thereafter. The level of fluconazole use remained stable (median 22.6 DDD/100 PD) over the course of the study and reflects prophylactic use. Posaconazole was introduced in 2007 as an antifungal therapeutic agent, but it has rarely been applied as prophylaxis at this hospital. The consumption of antifungals is shown in Figure 3.Figure 3


Weekly use of fluconazole as prophylaxis in haematological patients at risk for invasive candidiasis.

Vuichard D, Weisser M, Orasch C, Frei R, Heim D, Passweg JR, Widmer AF - BMC Infect. Dis. (2014)

Antifungal use on RIHU from 2004–2012 in defined daily dosages (DDD) per 100 patient days. * Liposomal and conventional (cholesteryl sulfate complex) amphotericin B.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4233028&req=5

Fig3: Antifungal use on RIHU from 2004–2012 in defined daily dosages (DDD) per 100 patient days. * Liposomal and conventional (cholesteryl sulfate complex) amphotericin B.
Mentions: The use of voriconazole over the same time span exceeded the median amphotericin use slightly with 28.8 DDD/100 PD. Caspofungin consumption increased markedly from 3.5 DDD/100 PD in 2004 to 14.1 DDD/100 PD in 2006, but its use changed only minimally thereafter. The level of fluconazole use remained stable (median 22.6 DDD/100 PD) over the course of the study and reflects prophylactic use. Posaconazole was introduced in 2007 as an antifungal therapeutic agent, but it has rarely been applied as prophylaxis at this hospital. The consumption of antifungals is shown in Figure 3.Figure 3

Bottom Line: Overall, Candida glabrata was the predominant species with 29% followed by C. albicans and C. krusei (14% each).No significant increment of non-albicans Candida species with decreased fluconazole susceptibility was perceived over this decade.Once weekly administration of 400 mg of fluconazole to prevent candidaemia appears to have no negative impact on the efficacy as a prophylaxis when compared to standard of care (400 mg of fluconazole daily).

View Article: PubMed Central - PubMed

ABSTRACT

Background: The goal was to determine whether one medical centres' unique antifungal prophylactic regimen for patients at high risk for invasive candidiasis because of their haematological malignancies, haematopoietic stem cell transplants, or high-dose chemotherapy might lead ultimately to a higher incidence of infection, to increasing fluconazole resistance, or to a shift in the predominant strain of Candida in invasive fungal episodes.

Methods: Data were collected retrospectively, for a ten-year period from ONKO-KISS surveillance records, and from hospital, medical, and pharmacy records and then evaluated with respect to incidence of fungal infection episodes, emergence of antifungal drug resistance, and predominance of specific Candida strains in isolate cultures. Fisher's exact test and linear regression were used to compare minimum inhibitory concentrations and to compare the incidence of different Candida isolates, respectively.

Results: The incidence of infection remained quite stable over 10 years with a median of 0.67 episodes/1000 bed days. Overall, Candida glabrata was the predominant species with 29% followed by C. albicans and C. krusei (14% each). No significant increment of non-albicans Candida species with decreased fluconazole susceptibility was perceived over this decade.

Conclusions: Once weekly administration of 400 mg of fluconazole to prevent candidaemia appears to have no negative impact on the efficacy as a prophylaxis when compared to standard of care (400 mg of fluconazole daily).

Show MeSH
Related in: MedlinePlus