Success Rate and Risk Factors for Failure of Empirical Antifungal Therapy with Itraconazole in Patients with Hematological Malignancies: A Multicenter, Prospective, Open-Label, Observational Study in Korea

被引：5

作者：

Kim, Soo-Jeong ^{[1
]}

Cheong, June-Won ^{[1
]}

Min, Yoo Hong ^{[1
]}

Choi, Young Jin ^{[2
]}

Lee, Dong-Gun ^{[3
]}

Lee, Je-Hwan ^{[4
]}

Yang, Deok-Hwan ^{[5
]}

Lee, Sang Min ^{[6
]}

Kim, Sung-Hyun ^{[7
]}

Kim, Yang Soo ^{[8
]}

Kwak, Jae-Yong ^{[9
]}

Park, Jinny ^{[10
]}

Kim, Jin Young ^{[11
]}

Kim, Hoon-Gu ^{[12
]}

Kim, Byung Soo ^{[13
]}

Ryoo, Hun-Mo ^{[14
]}

Jang, Jun Ho ^{[15
]}

Kim, Min Kyoung ^{[16
]}

Kang, Hye Jin ^{[17
]}

Cho, In Sung ^{[18
]}

Mun, Yeung Chul ^{[19
]}

Jo, Deog-Yeon ^{[20
]}

Kim, Ho Young ^{[21
]}

Park, Byeong-Bae ^{[22
]}

Kim, Jin Seok ^{[1
]}

机构：

[1] Yonsei Univ, Severance Hosp, Coll Med, Div Hematol,Dept Internal Med, Seoul 120752, South Korea

[2] Pusan Natl Univ, Pusan Natl Univ Hosp, Sch Med, Dept Hematol Oncol, Pusan, South Korea

[3] Catholic Univ Korea, Seoul St Marys Hosp, Dept Internal Med, Seoul, South Korea

[4] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Hematol, Seoul, South Korea

[5] Chonnam Natl Univ, Dept Hematol Oncol, Hwasun Hosp, Hwasun, South Korea

[6] Inje Univ, Busan Paik Hosp, Dept Internal Med, Pusan, South Korea

[7] Dong A Univ, Coll Med, Dept Internal Med, Pusan, South Korea

[8] Kosin Univ, Gospel Hosp, Dept Internal Med, Pusan, South Korea

[9] Chonbuk Natl Univ, Sch Med, Dept Internal Med, Jeonju, South Korea

[10] Gachon Univ, Gil Med Ctr, Dept Internal Med, Inchon, South Korea

[11] Keimyung Univ, Sch Med, Dongsan Med Ctr, Dept Internal Med, Taegu, South Korea

[12] Gyeongsang Natl Univ, Gyeongsang Natl Univ Hosp, Sch Med, Dept Internal Med, Jinju, South Korea

[13] Korea Univ, Med Ctr, Dept Internal Med, Seoul, South Korea

[14] Daegu Catholic Univ, Med Ctr, Dept Internal Med, Taegu, South Korea

[15] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Dept Med, Seoul, South Korea

[16] Yeungnam Univ, Coll Med, Dept Internal Med, Taegu, South Korea

[17] Korea Inst Radiol & Med Sci, Korea Canc Ctr Hosp, Dept Internal Med, Seoul, South Korea

[18] Eulji Univ Hosp, Dept Internal Med, Taejon, South Korea

[19] Ewha Womans Univ, Sch Med, Dept Internal Med, Seoul, South Korea

[20] Chungnam Natl Univ, Chungnam Natl Univ Hosp, Coll Med, Dept Internal Med, Taejon, South Korea

[21] Hallym Univ, Sacred Heart Hosp, Dept Internal Med, Anyang, South Korea

[22] Hanyang Univ, Coll Med, Dept Internal Med, Seoul 133791, South Korea

来源：

JOURNAL OF KOREAN MEDICAL SCIENCE | 2014年 / 29卷 / 01期

关键词：

Hematological Malignancy; Itraconazole; Empirical Antifungal Therapy; Galactomannan Test; LIPOSOMAL AMPHOTERICIN-B; INFECTIOUS-DISEASES SOCIETY; STEM-CELL TRANSPLANTATION; NEUTROPENIC PATIENTS; INVASIVE ASPERGILLOSIS; PERSISTENT FEVER; FUNGAL-INFECTIONS; CANCER; GALACTOMANNAN; GUIDELINES;

D O I：

10.3346/jkms.2014.29.1.61

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

We assessed the success rate of empirical antifungal therapy with itraconazole and evaluated risk factors for predicting the failure of empirical antifungal therapy. A multicenter, prospective, observational study was performed in patients with hematological malignancies who had neutropenic fever and received empirical antifungal therapy with itraconazole at 22 centers. A total of 391 patients who had abnormal findings on chest imaging tests (31.0%) or a positive result of enzyme immunoassay for serum galactomannan (17.6%) showed a 56.5% overall success rate. Positive galactomannan tests before the initiation of the empirical antifungal therapy (P = 0.026, hazard ratio [ HR], 2.28; 95% confidence interval [CI], 1.10-4.69) and abnormal findings on the chest imaging tests before initiation of the empirical antifungal therapy (P = 0.022, HR, 2.03; 95% CI, 1.11-3.71) were significantly associated with poor outcomes for the empirical antifungal therapy. Eight patients (2.0%) had premature discontinuation of itraconazole therapy due to toxicity. It is suggested that positive galactomannan tests and abnormal findings on the chest imaging tests at the time of initiation of the empirical antifungal therapy are risk factors for predicting the failure of the empirical antifungal therapy with itraconazole.

引用

页码：61 / 68

页数：8

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