PRIMARY PROPHYLAXIS OF INVASIVE ASPERGILLOSIS WITH ITRACONAZOLE DURING EXTENSIVE CONSTRUCTION WORKS: A PRELIMINARY OPEN STUDY.
Invasive aspergillosis (IA) is a life threatening opportunistic infection in severely neutropenic patients (pts). It is usually acquired by inhalation of airborne fungal conidia. Extensive construction and renovation works in hospitals are a well documented source of nosocomial IA The potential benefit of a chemoprophylactic regimen has not been evaluated in such pts. We report the preliminary results of itraconazole (Itra) as a primary prophylaxis of IA in neutropenic pts during renovation works. From the first of July to the end of August 1993, renovation works were performed in one part of our Department located on the same floor than the Hematology Unit. Renovation sites were isolated with impermeable plastic barriers, but fungal contamination of the air (including Aspergillus sp. conidia) was demonstrated. We could not remove our pts from renovation sites. We thus decided to administrate Itra (400 mg OD) to all neutropenic pts. During this period, 9 pts experienced 10 episodes of severe and prolonged neutropenia (neutrophils < 500/mm3, >_14 d). Itra was given in all pts but 2 presenting with vomiting. Systematic evaluation of fungal colonization was performed once a week by taking multiple samples (mouth, stools, urine, vagina, Aspergillus antigen detection, and blood cultures in case of fever). The 7 pts treated with Itra were aged 24 to 63 years. They had acute myeloblastic leukemia (AML) (n=6) or hairy cell leukemia (HCL) (n=1). Three of them experienced fungal infections during a previous episode of neutropenia (fungemia due to C. albicans, funguria due to C. tropicalis or A. flavus ethmoidal sinusitis). Other risk factors for IA were HIV infection in one (last CD4 count: 166/mm3), previous autologous bone marrow transplantation (BMT) in one and major lymphopenia and monocytopenia due to HCL and its related treatment in one pt. Two pts aged 43 and 67-years did not receive Itra. They had acute lymphoblastic leukemia (ALL) and ANIL. The pt with ALL had undergone autologous BMT and received steroid therapy. The mean duration of neutropenia was 32 d (14-69 d) in prophylactically treated pts and 42 to 90 d in the two untreated pts. All pts experienced systemic infections which required prolonged broad-spectrum antibacterial therapy. All fungal samples remained negative excepted for the pt with ALL who developped IA due to A. flavus. directly responsible for death. Itra appeared well tolerated in all these pts. In conclusion of this preliminary study, Itra was effective as a primary prophylaxis of IA during hospital renovation and construction works despite a major airborne fungal contamination.
Full conference title:
The 2nd Meeting of the European Confederation of Medical Mycology