Breakthrough mycosis in HSCT recipients receiving micafungin prophylaxis

Ref ID: 17698

Author:

A. Cheng*, H.Y. Sun, B.S.K. Ko, H.F. Tien, Y.C. Chen,
S.C. Chang

Author address:

(Taipei, TW)

Full conference title:

22nd European Congress of Clinical Microbiology and Infectious Diseases

Abstract:

Objectives: To assess incidence and risk factors of breakthrough
mycosis under micafungin prophylaxis for hematopoietic stem cell
transplantation (HSCT).
Methods: A total of 50 HSCT recipients receiving micafungin as
prophylaxis in 2010-2011 were analyzed. Patients were followed for
100 days post-transplantation for the development of mycosis defined
by EORTC.
Results: Of the 50 patients, 38% received HSCT for lymphoma, 18%
for AML, 14% for ALL, and 14% for MDS; 40% received allogenetic
and 36% autologous HSCT. Breakthrough mycosis developed in 4
(8%) patients, including probable aspergillosis in 3 and definite
trichosporosis in 1, after a median of 6 days post-transplant and after
micafungin use for a median of 16 days. Of the three patients with
probable aspergillosis, persistent elevation of aspergillus antigen levels
and newly developed pulmonary nodules were the most common
presentations. The case with trichosporosis developed fever and
disseminated papular rash, and Trichosporon species was isolated
from the blood. All these four patients were successfully treated with
voriconazole. Compared with 46 patients without breakthrough
mycosis, positive cases were more like to be older (mean, 53 vs.
43 years old, p < 0.05) and had graft-versus-host-disease (50% vs. 28.3%, p > 0.05). All patients had surveillance nasal and throat fungal
cultures post-transplant, and 10 patients had positive results, including
C. albican in seven patients, C. glabrata in 1, unidentified Candida
species in 1, Trichosporon species in 1, and Mycelium sterile in 1.
Conclusion: The incidence of breakthrough mycosis during
micafungin prophylaxis for HSCT was 8%. Although micafungin had
anti-Aspergillus attribute, aspergillosis was the most common
breakthrough mycosis.

Abstract Number: NULL

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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