Prophylaxis of Fungal Infections in Neutropenic Patients with Hematologic Malignancies

Abstract

Prophylaxis against invasive fungal infection (IFI) in neutropenic patients remains a cornerstone of antifungal strategies mainly because diagnosis of fungal infections remains fraught with problems and the therapy of clinically overt infection, especially with molds, remains associated with high mortality. For most hematological diseases, the current therapeutic strategy relies on repetitive courses of chemotherapy. After an episode of IFI the risk of recurrence of the infections in a new episode of neutropenia is substantial. Therefore case-fatality rates of IFI do not reflect the entire prognostic impact of these infections, as the further therapy of the respective underlying disease may be hampered, delayed or entirely impossible. Overall mortality rates of IFI have been reported in the range of 47–64% [1]. [2]Subgroups of patients with e.g. allogeneic transplants, graft versus host disease (GVHD) and concurrent infections (CMV) my do substantially worse, with case fatality rates of 85–100% [3].