Clinical impact of enhanced diagnosis of invasive fungal disease in high-risk haematology and stem cell transplant patients
- 1Department of Medical Microbiology, School of Medicine, Cardiff University, Cardiff, Wales, UK
- 2NPHS Microbiology Cardiff, University Hospital of Wales, Cardiff, Wales, UK
- 3Department of Haematology, University Hospital of Wales, Cardiff, Wales, UK
- 4Pharmacy Department, University Hospital of Wales, Cardiff, Wales, UK
- Dr R A Barnes, Department of Medical Microbiology, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, Wales, UK;
- Accepted 15 August 2008
Aims: To investigate the impact of routine use of biomarkers for diagnosing fungal infection within a care pathway on antifungal usage and clinical outcomes.
Methods: A cohort of high-risk haematology and stem cell transplant patients was entered into a neutropenic care pathway in which targeted diagnostic testing replaced empiric antifungal treatment. Patients were screened twice a week by PCR and antigen testing during fever or when chronic graft versus host disease was present and were followed-up for a minimum of 1 year.
Results: No excess morbidity or mortality was seen in patients in whom empiric antifungal treatment was withheld, and there were substantial savings in antifungal drug expenditure.
Conclusions: The introduction of a comprehensive diagnostic surveillance strategy to exclude invasive fungal infection in high-risk patients with haematological malignancy and those undergoing transplantation can result in improvements in clinical management. There are also potential additional benefits of improved patient survival, decreased morbidity and decreased hospital stay.
Competing interests: RAB serves or has served on UK advisory boards for a variety of antifungal agents, including voriconazole (Pfizer), caspofungin (MSD), AmBisome (Gilead) and posaconazole (Schering-Plough), and received sponsorship to attend international meetings and honoraria for educational lectures from these companies. JK serves or has served on a UK advisory board for caspofungin (MSD).