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

Abstract

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