Doan, T.N., Kirkpatrick, C.M., Walker, P., Slavin, M.A., Ananda-Rajah, M.R., Morrissey, C.O., . . . Kong, D.C. (2016). Primary antifungal prophylaxis in adult patients with acute lymphoblastic leukaemia: A multicentre audit. The Journal of Antimicrobial Chemotherapy, 71, 497–505. 

DOI Link

Study Purpose

To investigate practices for antifungal prophylaxis and incidence of invasive fungal disease (IFD)

Intervention Characteristics/Basic Study Process

A retrospective chart review was conducted to collect data on patients from beginning of induction to completion of consolidation regarding the use of antifungal prophylaxis and IFD outcomes. Cost analysis was included.

Sample Characteristics

  • N = 98   
  • MEDIAN AGE = 43 years
  • MALES: 65%, FEMALES: 35%
  • CURRENT TREATMENT: Chemotherapy
  • KEY DISEASE CHARACTERISTICS: All had acute lymphoblastic leukemia

Setting

  • SITE: Multi-site   
  • SETTING TYPE: Inpatient    
  • LOCATION: Australia

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Study Design

Retrospective

Measurement Instruments/Methods

European Organization for Research and Treatment of Cancer (EORTC) criteria for proven, possible, or probable IFD

Results

Ninety-eight percent had neutropenia ranging from 18–45 days in duration. Prophylactic antifungal agents were given to 85% of patients. The only significant difference between those who developed IFD and those who did not was the use of antifungal prophylaxis. Those receiving prophylaxis had a lower incidence of proven or probable IFD  (2.6%) than others (21.4%) (p = 0.024). IFD incidence was highest in patients receiving BFM95 treatment (hyper-CVAD: hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone). Cost of care for those with IFD was significantly higher from hospitalization, diagnostic testing, and antifungal treatment costs (p < 0.001).

Conclusions

The use of antifungal prophylaxis was associated with a lower incidence of IFD and associated healthcare costs.

Limitations

  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)

 

Nursing Implications

Antifungal prophylaxis in at-risk patients was shown to be effective in reducing the incidence of IFD and associated healthcare costs.