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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

Authors
Kim, Soo-JeongCheong, June-WonMin, Yoo HongChoi, Young JinLee, Dong-GunLee, Je-HwanYang, Deok-HwanLee, Sang MinKim, Sung-HyunKim, Yang SooKwak, Jae-YongPark, JinnyKim, Jin YoungKim, Hoon-GuKim, Byung SooRyoo, Hun-MoJang, Jun HoKim, Min KyoungKang, Hye JinCho, In SungMun, Yeung ChulJo, Deog-YeonKim, Ho YoungPark, Byeong-BaeKim, Jin Seok
Issue Date
1월-2014
Publisher
KOREAN ACAD MEDICAL SCIENCES
Keywords
Hematological Malignancy; Itraconazole; Empirical Antifungal Therapy; Galactomannan Test
Citation
JOURNAL OF KOREAN MEDICAL SCIENCE, v.29, no.1, pp.61 - 68
Indexed
SCIE
SCOPUS
KCI
Journal Title
JOURNAL OF KOREAN MEDICAL SCIENCE
Volume
29
Number
1
Start Page
61
End Page
68
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/99744
DOI
10.3346/jkms.2014.29.1.61
ISSN
1011-8934
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.
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