Yüksek riskli hematolojik maligniteli hastaların febril nötropenik ataklarında antifungal tedavi stratejilerinin değerlendirilmesi
Loading...
Files
Date
2010
Authors
Acet, Aycan
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Nötropenik hastalar invaziv fungal infeksiyon (İFİ) gelişimi için yüksek risk altındadırlar. Bu hastaların tedavisi için vakit kaybetmeden antifungal tedavi düşünülmelidir. Günümüzde İFİ düşünülen nötropenik ateşli hastalarda empirik ve preemptif adı altında iki tedavi stratejisi kullanılmaktadır. Empirik tedavi ile ilaç toksisitesi, tedavi maliyet artışı gibi sıkıntılar yaşanabilirken, preemptif tedavide fungal infeksiyonun tedavisi gecikebilmektedir. Bu çalışmanın amacı yüksek riskli hematolojik maligniteli hastalarda empirik ve preemptif tedavi stratejilerini değerlendirmektir. Çalışmamızda; Hematoloji Bilim Dalı Kliniğimizde Haziran 2006-Ocak 2009 tarihleri arasında yatarak tedavi gören 281 hematolojik maligniteli hastanın 402 febril nötropenik (FEN) atağını inceledik. Antifungal ilaç kullanılan 104 hastanın 154 febril nötropenik atağı mevcuttu. Empirik antifungal tedavi verilen 62 FEN atağı, preemptif tedavi verilen 55 FEN atağı bulunmakta idi. İki tedavi grubu arasında tüm nedenlere bağlı mortalite, antifungal ilaçlara bağlı yan etki görülme sıklığı ve tedaviyi bıraktırmayı gerektirecek derecede ciddi yan etki sıklığı açısından anlamlı bir fark saptanmadı. Vorikonazol ve kaspofungine bağlı tedaviyi bıraktırmayı gerektirecek derecede ciddi yan etki saptanmadı. Sonuç olarak, yüksek riskli hematolojik maligniteli hastalarda preemptif tedavi empirik tedavi yerine kullanılabilir. Kaspofungin ve vorikonazol güvenle kullanılabilecek antifungal ilaçlardır.
Neutropenic patients are at high risk to develop invasive fungal infections (IFI). Immediate antifungal treatment should be considered necessary for the treatment of these patients. To date, two treatment strategies are used for patients with fever in neutropenia and suspected IFI: empirical or preemptive antifungal therapy. Empirical treatment bears the danger of 'overtreatment' with potentially toxic and expensive drugs, whereas preemptive therapy may sometimes be initiated too late to work efficiently against fungal disease.The aim of this study was to evaluate empiric and preemptive antifungal treatment in high risk hematological malignancies patients. In our study, we evaluate 402 febrile neutropenic (FEN) episodes in 281 patients with hematologic malignancy who were followed in hematology in patient clinic between June 2006 and January 2009. One hundred and four patients on antifungal therapy had 154 FEN episodes. There were 62 FEN episodes in empiric antifungal treatment group and 55 FEN episodes in preemptive antifungal treatment group. There were no significant differences deteched between two groups which are overall mortality, frequences of side effects which were caused by antifungal agents, serious side effects frequency were caused to terminate antifungal treatment. In conclusion, preemptive antifungal treatment can be used for patients with high risk hematologic malignancy to substitude empiric antifungal treatment. In the antifungal treatment vorikonazole and caspofungin can be safely used.
Neutropenic patients are at high risk to develop invasive fungal infections (IFI). Immediate antifungal treatment should be considered necessary for the treatment of these patients. To date, two treatment strategies are used for patients with fever in neutropenia and suspected IFI: empirical or preemptive antifungal therapy. Empirical treatment bears the danger of 'overtreatment' with potentially toxic and expensive drugs, whereas preemptive therapy may sometimes be initiated too late to work efficiently against fungal disease.The aim of this study was to evaluate empiric and preemptive antifungal treatment in high risk hematological malignancies patients. In our study, we evaluate 402 febrile neutropenic (FEN) episodes in 281 patients with hematologic malignancy who were followed in hematology in patient clinic between June 2006 and January 2009. One hundred and four patients on antifungal therapy had 154 FEN episodes. There were 62 FEN episodes in empiric antifungal treatment group and 55 FEN episodes in preemptive antifungal treatment group. There were no significant differences deteched between two groups which are overall mortality, frequences of side effects which were caused by antifungal agents, serious side effects frequency were caused to terminate antifungal treatment. In conclusion, preemptive antifungal treatment can be used for patients with high risk hematologic malignancy to substitude empiric antifungal treatment. In the antifungal treatment vorikonazole and caspofungin can be safely used.
Description
Keywords
İnvaziv fungal infeksiyon, Empirik antifungal tedavi, Preemptif antifungal tedavi, Hematolojik malignite, Nötropenik ateş, Invasive fungal infection, Empirical antifungal treatment, Preemptive antifungal treatment, Hematological malignancy, Neutropenic fever
Citation
Acet, A. (2010). Yüksek riskli hematolojik maligniteli hastaların febril nötropenik ataklarında antifungal tedavi stratejilerinin değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.