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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

Title
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
Author
박병배
Keywords
Hematological Malignancy; Itraconazole; Empirical Antifungal Therapy; Galactomannan Test
Issue Date
2014-01
Publisher
KOREAN ACAD MEDICAL SCIENCES, 302 75 DONG DU ICHON, DONG YONGSAN KU, SEOUL 140 031, SOUTH KOREA
Citation
J Korean Med Sci, 2014 Jan, 29(1), p.61-68
Abstract
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.
URI
https://synapse.koreamed.org/search.php?where=aview&id=10.3346/jkms.2014.29.1.61&code=0063JKMS&vmode=FULLhttp://hdl.handle.net/20.500.11754/53806
ISSN
1011-8934; 1598-6357
DOI
10.3346/jkms.2014.29.1.61
Appears in Collections:
COLLEGE OF MEDICINE[S](의과대학) > ETC
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