评估泊沙康唑抗真菌预防治疗在降低急性髓系白血病患者侵袭性曲霉菌感染发生率中的作用。

Evaluation of posaconazole antifungal prophylaxis in reducing the incidence of invasive aspergillosis in patients with acute myeloid leukemia.

机构信息

Department of Haematology, Brest Teaching Hospital, Brest, France; Department of Internal Medicine, Infectious Diseases and Haematology, Cornouaille Hospital Quimper, Quimper, France.

Infection Control Unit, Brest Teaching Hospital, Brest, France.

出版信息

Curr Res Transl Med. 2020 Jan;68(1):23-28. doi: 10.1016/j.retram.2019.11.002. Epub 2019 Nov 28.

DOI:10.1016/j.retram.2019.11.002

PMID:31787568

Abstract

PURPOSE OF THE STUDY

Invasive aspergillosis (IA) is the most prevalent invasive fungal disease (IFD) in neutropenic patients. Environment is the main source of Aspergillus spores aerosolization especially during building construction. International guidelines recommend mechanical protection during hospital building works; otherwise the use of antifungal prophylaxis is not clearly indicated. Our objective was to determine the efficacy of antifungal prophylaxis by posaconazole on IA incidence in acute myeloid leukemia population and to analyse the benefit of this prophylaxis and HEPA-filters during hospital buildings works.

PATIENTS AND METHODS

We included patients treated for acute myeloid leukemia at Brest teaching hospital from January 2009 to December 2015. We compared incidence of IA in the group treated by posaconazole from 2012 to 2015 to the incidence of IA in the first group who did not receive antifungal prophylaxis (from 2009 to 2011). The one-year overall survival was also analyzed using the Kaplan-Meier method.

RESULTS

245 patients were enrolled including 151 treated with posaconazole. 23 IA were diagnosed between 2009 and 2011 (without antifungal prophylaxis), then 31 between 2012 and 2015 (with posaconazole) without statistical difference between the incidence densities (0.34 per 100 hospitalization-days vs. 0.30 per 100 hospitalization-days, p = 0.71). Incidence density of IA increased during building works (2.40 per 100 hospitalization-days vs. 0.28 per 100 hospitalization-days, p < 0.0001). The incidence density of IA significantly decreased during construction periods when posaconazole prophylaxis was used (1.59 per 100 hospitalization-days vs. 4.87 per 100 hospitalization-days p < 0.0001).

CONCLUSION

Our study suggests, for the first time, the interest of antifungal prophylaxis in addition to HEPA filtration in prevention of IA during hospital building works.

摘要

研究目的

侵袭性曲霉病（IA）是中性粒细胞减少症患者中最常见的侵袭性真菌病（IFD）。环境是曲霉孢子气悬的主要来源，特别是在建筑施工期间。国际指南建议在医院建筑工程期间进行机械保护；否则，使用抗真菌预防措施并不明确。我们的目的是确定泊沙康唑在急性髓系白血病患者中预防侵袭性曲霉病（IA）的疗效，并分析在医院建筑工程期间使用这种预防措施和高效空气过滤器（HEPA）的益处。

患者和方法

我们纳入了 2009 年 1 月至 2015 年 12 月在布雷斯特教学医院接受治疗的急性髓系白血病患者。我们比较了 2012 年至 2015 年接受泊沙康唑治疗的患者与未接受抗真菌预防（2009 年至 2011 年）的患者中侵袭性曲霉病的发生率。使用 Kaplan-Meier 方法分析了一年的总生存率。

结果

共纳入 245 例患者，其中 151 例接受泊沙康唑治疗。2009 年至 2011 年期间未使用抗真菌预防措施诊断出 23 例侵袭性曲霉病，随后 2012 年至 2015 年期间使用泊沙康唑治疗诊断出 31 例侵袭性曲霉病，发病率密度无统计学差异（每 100 住院日 0.34 例 vs. 每 100 住院日 0.30 例，p=0.71）。建筑工程期间侵袭性曲霉病的发病率密度增加（每 100 住院日 2.40 例 vs. 每 100 住院日 0.28 例，p<0.0001）。当使用泊沙康唑预防时，建筑期间侵袭性曲霉病的发病率密度显著降低（每 100 住院日 1.59 例 vs. 每 100 住院日 4.87 例，p<0.0001）。