Peterson, L., Ostermann, J., Rieger, H., Ostermann, H., & Rieger, C.T. (2013). Posaconazole prophylaxis—impact on incidence of invasive fungal disease and antifungal treatment in haematological patients. Mycoses, 56, 651–658.

DOI Link

Study Purpose

To evaluate the impact of antifungal prophylaxis in patients with hematologic cancers

Intervention Characteristics/Basic Study Process

Retrospective analysis of medical records was used to compare invasive fungal infection outcomes among patients who received prophylactic posaconazole and a historical cohort treated prior to the implementation of standard prophylaxis. Prophylaxis was used in high-risk patients.

Sample Characteristics

  • N = 200 (100 historical controls)
  • MEAN AGE = 51 years
  • AGE RANGE = 18–77 years
  • MALES: 50%        
  • FEMALES: 50%
  • KEY DISEASE CHARACTERISTICS: Patients had acute myeloid leukemia or myelodysplastic syndromes or received hematopoietic cell transplantation 

Setting

  • SITE: Single site 
  • SETTING TYPE: Multiple settings 
  • LOCATION: Germany

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment

Study Design

  • Retrospective, descriptive with historical control comparison

Measurement Instruments/Methods

  • Aspergillus testing
  • Weekly stool samples and mouth swabs
  • European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria for possible, probable, or proven invasive fungal disease (IFD)

Results

Mean duration of posaconazole prophylaxis was 21.7 days. Comparisons showed that 43% of controls had no IFD, compared to 72% of those with prophylaxis. Possible IFD was seen in 43% of controls and 24% of those on posaconazole.  Probable IFD was 7% in controls, compared to 4% of those getting prophylaxis. No cases of IFD were proven among patients receiving prophylaxis, compared to 7% of controls with proven IFD. Forty-one percent of those on prophylaxis required antifungal therapy, compared to 91% of controls.

Conclusions

Findings showed that routine posaconazole prophylaxis in high-risk patients was associated with substantial reduction in the incidence of IFD and treatment with antifungal therapy.

Limitations

  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Other limitations/explanation: The definition of high-risk used for the intervention was not specifically described.

Nursing Implications

Findings support the routine use of antifungal prophylaxis in high-risk patients with cancer.