Table 2.
Clinical characteristics and putcome of breackthrough IFI.
| Case | Underlying disease | Type of HSCT | Micafungin dose (mg/d) |
Duration (days) | Days from micafungin initiation to IFI diagnosis | Compatible radiological findings with IFI | Mycological criteria for IFI | EORTC IFI grade | Change to directed antifungal treatment | Outcome | Cause of death | IFI-relateddeath |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Leukaemia | UC | 50 | 29 | 10 | Yes | Positive GMN | Probable | No | Death | MOF | No |
| 2 | Leukaemia | PB | 50 | 12 + 11 | N/A | Yes | Positive GMN | Probable | Yesa | Death | S. aureus bacteremia | No |
| 3 | Lymphoma | PB | 50 | 14 | 13 | Yes | Positive GMN | Probable | Yesb | Successful | -- | -- |
| 4 | MDS | PB | 50 | 25 | 17 | Yes | Positive GMN | Probable | Yesc | Successful | -- | -- |
| 5 | Lymphoma | PB | 50 | 6 + 15 | N/A | Yes | Positive GMN | Probable | Yesd | Death | MOF | No |
| 6 | Lymphoma | PB | 50 | 10 | 10 | Yes | Positive GMN Aspergillus flavus in sputum sample |
Probable | Yese | Death | VOD | No |
| 7 | Leukaemia | PB | 50 | 25 | 24 | No | Fusarium solani in skin biopsy | Proven | Yesb | Successful | -- | -- |
HSCT: Hematopoietic stem cell transplant; IFI: Invasive fungal infection; MDS: myelodysplastic syndrome; UC: umbilical cord; PB: peripheral blood; BM: bone marrow; GMN: galactomannan; MOF: multiple organ failure failure; VOD: veno-occlusive disease; N/A: not applicable.
Case 2 received 12 days of primary prophylaxis with micafungin, substituted for liposomal amphotericin during 11 days, changed again to micafungin at dose of 50mg/d during 11 days, and after changed again to liposomal amphotericin during 20 days and finally to caspofungin for 4 days. The first positive galactomannan was at the end of treatment with caspofungin (24 days after the last dose of micafungin). Treating clinicians considered failure of prophylaxis with micafungin.
Not specified.
To voriconazole.
Case 5 received initially 6 days of primary prophylaxis with micafungin. He developed fever and a lobar infiltrate evident on chest x-ray and directed treatment with liposomal amphotericin was started for 19 days. Prophylaxis with micafungin was restarted at dose of 50mg/d. After 15 days, bilateral nodules and pleural effusion compatible with IFI were evident on the CT scan. Two determinations for GMN were positive and directed treatment with caspofungin was started. Treating clinicians considered failure of prophylaxis with micafungin.
To liposomal amphotericin.