The Role of Fluconazole Prophylaxis Regimen and the Regimes Chosen by the Patient’s Risk of Fungal Infection in Reducing the Infection Rate after Bone Marrow Transplantation

Document Type: Research Articles

Authors

1 Department of Internal Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.

2 Bone Marrow Transplantation Ward, (Ayatollah) Taleghani Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Objective: Invasive fungal infections (IFI) in bone marrow transplant (BMT) recipients are common and lethal.
Fluconazole was the choice prophylaxis previously, but recent strategy utilization antifungal drugs according to the risk
of IFI in patients undergoing transplantation. In this study we aim to evaluate the efficacy of fluconazole prophylaxis
regimen and the regimes chosen by the patient’s risk of IFI. Materials and Methods: We evaluated 376 patients with
BMT. Patients were divided into those treated before 2012 with fluconazole prophylaxis (group I, n=206) or those
undergone transplantation after 2012 and received fluconazole, voriconazole and posaconazole prophylaxis according
their risk of fungal infection (group II, n=170). Results: Group I was significantly younger (p=0.007), less smoker
(p=0.01), received more autologus transplant (p=0.001) and mostly high risk patient for infection (p<0.001). Group
I had significantly higher duration of fever (p=0.004) and increased WBC (p=0.02), longer length of stay (p=0.001),
more proven and less probable fungal infections (p=0.008) and higher hepatic complications (p=0.003). There was no
significant difference in fungal related and overall mortality rate between groups. Conclusion: The use of prophylaxis
based on risk of fungal infection in patients undergoing BMT results in reduce fungal infections, duration of fever and
accelerate the engraftment and patient discharge.

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