Summary
Fungal infections are a common complication in hematological and oncological patients. In the study the results of a retrospective analysis of the onset of fungal infections among 383 patients admitted at the hematology unit of San Camillo Hospital, Rome, from 1980 to 1995 are reported. In the eleven years prior to 1991 only four cases of fungal infection were detected in high risk patients (1.8% of the high risk patients). From 1991 to 1993 there was a dramatic increase of fungal infections (Candida andAspergillus). Thirteen cases of infections were observed during this period, eight of which were due toAspergillus (12% of the high risk patients). For this reason it was decided to introduce a different prophylactic treatment for all high risk patients consisting of combined conventional intravenous (i.v.) amphotericin B, oral amphotericin B and nebulized amphotericin B, starting from the first day of hospitalization. Since the introduction of this new prophylactic regimen no cases of invasive fungal infections were observed in the 48 high risk patients examined. The prophylactic treatment was well tolerated by all patients. The results suggest that the combined use of oral, nebulized and i.v. amphotericin B is very effective in preventing invasive fungal infections in high risk patients.
Zusammenfassung
Pilzinfektionen treten häufig als Komplikation bei Patienten mit hämatologisch-onkologischen Erkrankungen auf. In einer retrospektiven Analyse wurden die Daten von 383 Patienten, die zwischen 1980 und 1995 in die hämatologische Abteilung der Klinik San Camillo, Rom, eingewiesen wurden, einer systematischen Prüfung hinsichtlich des Auftretens von Pilzinfektionen unterzogen. In den 11 Jahren vor 1991 wurden bei Hochrisikopatienten nur vier Fälle von Pilzinfektionen beobachtet (1,8% der Hochrisikopatienten). Von 1991–1993 nahmen Infektionen durchCandida undAspergillus spp. dramatisch zu. In acht von 13 Fällen (12% der Hochrisikopatienten) warAspergillus der Erreger. Die Prophylaxe gegen Pilzinfektionen wurde daraufhin geändert. Hochrisikopatienten erhielten eine Prophylaxe mit einem neuen Schema, das die konventionelle Gabe von Amphotericin B i.v. mit oraler und inhalativer Applikation über Vernebler kombiniert. Bei 48 Hochrisikopatienten, die diese Prophylaxeregime erhielten, traten keine invasiven Pilzinfektionen auf. Die Patienten konnten das Schema gut vertragen. Aus den Ergebnissen läßt sich ableiten, daß die Anwendung von Amphotericin B in kombinierter oraler, inhalativer und intravenöser Form eine effektive Prophylaxe gegen Pilzinfektionen bei Hochrisikopatienten darstellt.
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De Laurenzi, A., Matteocci, A., Lanti, A. et al. Amphotericin B prophylaxis against invasive fungal infections in neutropenic patients: A single center experience from 1980 to 1995. Infection 24, 361–366 (1996). https://doi.org/10.1007/BF01716080
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DOI: https://doi.org/10.1007/BF01716080