Liu, M., Li, Y., Zhang, Y., Zhao, X., Zhai, B., Zhang, Q., . . . Yu, L. (2014). Secondary antifungal prophylaxis in hematological malignancy patients with previous invasive fungal disease: A retrospective analysis. PloS One, 9(12), e115461. 

DOI Link

Study Purpose

To investigate efficacy of various secondary antifungal prophylaxis regimens

Intervention Characteristics/Basic Study Process

Patients with hematological malignancy that had a previous diagnosis of probable or proven invasive fungal disease were reviewed retrospectively and followed for 180 days post-chemotherapy or transplantation. Antifungal prophylaxis was provided with voriconazole, itraconazole, amphotericin B, liposome, or caspofungin. Secondary prophylaxis began on the first day of conditioning or within two days before chemotherapy and was continued throughout the duration of neutropenia. It was ended when immunosuppression was finished in all patients undergoing HCT, or neutrophil recovery or failure of the prophylaxis.

Sample Characteristics

  • N = 164
  • AGE = 51% were older than age 40 years
  • MALES: 51%, FEMALES: 49%
  • KEY DISEASE CHARACTERISTICS: 90% had acute leukemia. More than one-third had acute or chronic graft-versus-host disease.
  • OTHER KEY SAMPLE CHARACTERISTICS: All had prior pulmonary invasive fungal disease.

Setting

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

Phase of Care and Clinical Applications

  • PHASE OF CARE: Multiple phases of care

Study Design

  • Retrospective

Measurement Instruments/Methods

Not applicable.

Results

121 patients received secondary antifungal prophylaxis. The recurrence rates were 16.5% and 46.5% in those receiving and not receiving prophylaxis, respectively (p = 0.000). There was no difference in recurrence rates according to the specific prophylactic agents used.

Conclusions

Findings suggest that secondary antifungal prophylaxis is beneficial in reducing the rate of recurrent fungal infections in patients with cancer.

Limitations

  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Measurement/methods not well described
  • Specific definition of fungal infection are not provided, and most only had probable infection due to lack of diagnostic data.

Nursing Implications

Secondary antifungal prophylaxis in patients who had previous invasive fungal infections was shown to be effective in reducing the rate of new fungal infections; however, it did not prevent fungal infection in all patients. Nurses need to closely monitor and assess these types of patients for signs of infection so that they can be treated aggressively when needed.