Gomes, M.Z., Jiang, Y., Mulanovich, V.E., Lewis, R.E., & Kontoyiannis, D.P. (2014). Effectiveness of primary anti-Aspergillus prophylaxis during remission induction chemotherapy of acute myeloid leukemia. Antimicrobial Agents and Chemotherapy, 58, 2775–2780. 

To analyze risk factors for breakthrough invasive fungal infection (IFI) in patients receiving remission-induction chemotherapy and evaluate effects of echinocandin versus triazole prophylaxis

Data were obtained from patients’ electronic medical records for antifungal use, documented IFI, type of chemotherapy, use of HEPA air filtration, duration of hospitalization, and neutropenia and mortality. Kaplan-Meier curves were used to estimate the probability of remaining IFI free based on prophylaxis strategy. Patient data were used up to IFI diagnosis, loss to follow-up, death, or completion of 120 days post-induction, whichever came first.

• N = 125
• MEDIAN AGE = 64 years
• AGE RANGE = 51–73 years
• MALES: 55%, FEMALES: 45%
• KEY DISEASE CHARACTERISTICS: AML undergoing remission induction. The majority were on cytarabine-based regimens.

• SITE: Single site  
• SETTING TYPE: Inpatient  
• LOCATION: Texas

• PHASE OF CARE: Active antitumor treatment

• Retrospective

• None—no definition of IFI provided

Those receiving echinocandin versus mold active triazole had higher incidence of IFI (0% in the triazole group, 8% in the echinocandin group, p = 0.09). All cause mortality did not differ between groups. Regimens containing clofarabine for induction was also an independent predictor of IFI (p = 0.004). Patients who died within 120 days of beginning induction chemotherapy were more likely to be female, had prior chemotherapy-related AML, had lung disease or infection, or had cardiovascular disease as a comorbid condition. Those receiving echinocandin also had more breakthrough yeast infections.

Findings suggest that primary antifungal prophylaxis during remission induction with echinocandin may be less effective in preventing IFI than prophylaxis with mold-active triazoles.

• Risk of bias (no control group)
• Risk of bias (no random assignment) 
• There were very few fungal infections overall, and a much lower sample size that received echinocandin.

Patients with AML undergoing remission-induction chemotherapy are at high risk for developing IFIs, particularly mold infections. Findings from this study suggest that the class of antifungal prophylaxis agent used influences the patient’s risk of IFI. Nurses should be aware of the potential increased risk for fungal and yeast infections in patients getting echinocandin prophylaxis. Further research in this area is warranted given the limitations of this study.