Antifungal management and resource use in patients with acute myeloid leukaemia after chemotherapy – retrospective analysis of changes over 3 yr in a German hospital

摘要: Prolonged and profound neutropenia, defined as an absolute neutrophil count of <500/μL for more than ten consecutive days, is a common severe complication during remission induction chemotherapy patients with acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS) (1). Invasive fungal infection (IFI) major cause mortality in neutropenia caused by haematologic malignancy, its therapy both. Fatality rates range from 60% to 90% even non-fatal IFIs complicate delay further chemotherapy, thereby impairing the treatment underlying disease (2, 3). The incidence IFI has increased within recent years, because rise number immunocompromised (4–6). Reasons are supposed be changes malignancies: formerly intensive cytotoxic treatment, nowadays increasing elderly treated curatively transplantations stem cells unrelated mismatch donors (5, 7). Early diagnosis difficult symptoms (e.g. fever dyspnoea) non-specific untreated become rapidly fatal. Therefore, antifungal prophylaxis commonly used management strategy patient populations 8). Most Candida species, but last epidemiology changed. adoption lead decrease invasive candidiasis, parallel occurrence resistant species increase infections Aspergillus other filamentous fungi (9, 10). Posaconazole, novel broad-spectrum azole, received approval European Medicines Agency (EMA) US Food Drug Administration (FDA) 2006 (11). efficacy posaconazole high-risk been shown superior that either fluconazole itraconazole (12). Conference on Infections Leukemia recommends allogeneic haematopoietic cell transplant recipients receiving 13). In addition morbidity affected patients, associated significant costs healthcare system. hospitalisation aspergillosis 2009 were estimated be, dependent disease, between $48 110 $80 468 higher those comparable without (14, 15). Budget constraints hospitals over time, introduction new substances indications resulting extended use gives objections about resource allocation possible cost increase. This study addresses patterns well related AML after hospital provider (HP) perspective Germany 2004 special focus IFI. To provide real-life data posaconazole, analysis was carried out also subgroup who had (PP) 2006.