Fisher, B.T., Kavcic, M., Li, Y., Seif, A.E., Bagatell, R., Huang, Y.S., . . . Aplenc, R. (2014). Antifungal prophylaxis associated with decreased induction mortality rates and resources utilized in children with new-onset acute myeloid leukemia. Clinical Infectious Diseases, 58, 502–508. 

To evaluate the effectiveness of antifungal prophylaxis in children with acute myeloid leukemia (AML)

Medical data for children newly diagnosed with AML were obtained from a database of hospitals associated with the Children's Hospital Association nationwide. Only patients with AML receiving induction therapy involving cytarabine, aunorubicin, and etoposide regimens were included. Patients were followed until inpatient death, loss to follow-up, or completion of induction. Data for antibiotic use, blood cultures, and chest CTs were obtained. Exposure to antifungal prophylaxis with any agent was obtained, and decision rules were used to ensure antifungals were used for prophylaxis rather than empiric therapy. Those who did not receive any antifungal agent during the first 21 days of induction chemotherapy were considered “no prophylaxis” patients. Outcomes were analyzed and compared for those who did and did not receive prophylaxis

• N = 871
• MEAN AGE = Not provided
• AGE RANGE = younger than 1 year to younger than 19 years
• MALES: 53.4%, FEMALES: 46.6%
• KEY DISEASE CHARACTERISTICS: All had AML and were receiving induction chemotherapy
• OTHER KEY SAMPLE CHARACTERISTICS: 69% were Caucasian

• SITE: Multi-site  
• SETTING TYPE: Inpatient  
• LOCATION: United States of America

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Pediatrics

• Retrospective cohort comparison

Of those who did not get antifungal prophylaxis, 5.32% died during induction compared to 2.42% of those receiving prophylaxis (RR = 0.42, 95% CI [0.19, 0.9]). Those receiving prophylaxis had less use of antibiotics and fewer blood cultures and CT scans. There was no significant difference in mortality between those receiving anti-mold prophylaxis and others.

Findings show that primary antifungal prophylaxis was associated with lower mortality and utilization of resources during induction for AML among pediatric patients.

• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• There was no demonstration of mortality related to invasive fungal infection.
• Cause of mortality is not discussed.

Findings suggest that primary antifungal prophylaxis among pediatric patients may reduce mortality and resource utilization. These findings support the use of antifungal prophylaxis among at-risk pediatric patients.