Success Rate and Risk Factors for Failure of Empirical Antifungal Therapy with Itraconazole in Patients with Hematological Malignancies: A Multicenter, Prospective, Open-Label, Observational Study in Korea

Title
Success Rate and Risk Factors for Failure of Empirical Antifungal Therapy with Itraconazole in Patients with Hematological Malignancies: A Multicenter, Prospective, Open-Label, Observational Study in Korea
Author(s)
김수정[김수정]김진석[김진석]정철원[정철원]민유홍[민유홍]최영진[최영진]이동건[이동건]이제환[이제환]양덕환[양덕환]이상민[이상민]김성현[김성현]김양수[김양수]곽재용[곽재용]박진희[박진희]김진영[김진영]김훈구[김훈구]김병수[김병수]류헌모[류헌모]장준호[장준호]김민경강혜진[강혜진]조덕연[조덕연]김호영[김호영]박병배[박병배]
Keywords
LIPOSOMAL AMPHOTERICIN-B; INFECTIOUS-DISEASES SOCIETY; STEM-CELL TRANSPLANTATION; NEUTROPENIC PATIENTS; INVASIVE ASPERGILLOSIS; PERSISTENT FEVER; FUNGAL-INFECTIONS; CANCER; GALACTOMANNAN; GUIDELINES
Issue Date
201401
Publisher
KOREAN ACAD MEDICAL SCIENCES
Citation
JOURNAL OF KOREAN MEDICAL SCIENCE, v.29, no.1, pp.61 - 68
Abstract
We assessed the success rate of empirical antifungal therapy with itraconazole and evaluated risk factors for predicting the failure of empirical antifungal therapy. A multicenter, prospective, observational study was performed in patients with hematological malignancies who had neutropenic fever and received empirical antifungal therapy with itraconazole at 22 centers. A total of 391 patients who had abnormal findings on chest imaging tests (31.0%) or a positive result of enzyme immunoassay for serum galactomannan (17.6%) showed a 56.5% overall success rate. Positive galactomannan tests before the initiation of the empirical antifungal therapy (P = 0.026, hazard ratio [ HR], 2.28; 95% confidence interval [CI], 1.10-4.69) and abnormal findings on the chest imaging tests before initiation of the empirical antifungal therapy (P = 0.022, HR, 2.03; 95% CI, 1.11-3.71) were significantly associated with poor outcomes for the empirical antifungal therapy. Eight patients (2.0%) had premature discontinuation of itraconazole therapy due to toxicity. It is suggested that positive galactomannan tests and abnormal findings on the chest imaging tests at the time of initiation of the empirical antifungal therapy are risk factors for predicting the failure of the empirical antifungal therapy with itraconazole.
URI
http://hdl.handle.net/YU.REPOSITORY/33546http://dx.doi.org/10.3346/jkms.2014.29.1.61
ISSN
1011-8934
Appears in Collections:
의과대학 > 내과학교실 > Articles
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