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Reducing Infections in Patients With AML Receiving Induction and Reinduction Chemotherapy

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Key Points

  • The initiative reduced the rate of proven/probable invasive fungal infections to 0%.
  • Hospital and intensive care unit length of stay were reduced under the program.

In a report in the Journal of Oncology Practice, Morris et al described an initiative that has been successful in reducing the incidence of invasive fungal infections in patients with acute myeloid leukemia (AML) receiving induction and reinduction therapy at the University of Virginia Health System.

The aim of the initiative was to reduce the proven or probable invasive fungal infection rate of 20% observed in the health system between May 2011 and August 2014 to 10% or less, a figure representative of national averages. The issues identified by a multidisciplinary team in reducing invasive fungal infection risk were standardized antifungal prophylaxis, staff education about neutropenic fever and signs/symptoms of invasive fungal infection, and standardized workup for patients with refractory or recurrent fevers.

A collaboration of infectious disease team members and the health system antimicrobial utilization committee produced a guideline for administering antifungal prophylaxis to all patients in this setting, while ensuring that patients becoming febrile on prophylaxis were appropriately evaluated to identify potential resistant organisms or suboptimal treatment of other infections. The guideline included recommended and alternative antifungal agents for prophylaxis, a timeline for duration of treatment, drug interactions, and the use of a mandatory consult clinical pathway for patients with refractory or recurrent fevers during prophylaxis.

Effect of Initiative

Between program implementation in August 2016 and August 2017, the rate of proven or probable invasive fungal infection was reduced to 0% among 38 patient encounters. Prophylaxis consisted of posaconazole in 36 encounters and micafungin in 2 encounters. Micafungin (Mycamine) was administered in addition to posaconazole (Noxafil) in 21 encounters to empirically treat recurrent fevers with no clear source.

The mean duration of micafungin treatment was 18 days. Compared with 74 patients who did not receive prophylaxis prior to the initiative, those who did receive prophylaxis had their mean length of hospital stay reduced by 3.4 days (from 29.3 to 25.9 days) and median intensive care unit length of stay reduced by 2 days (from 6 to 4 days).

The authors concluded, “Creation of a standardized antifungal prophylaxis program led to a marked decrease in [length of stay] and the proven or probable invasive fungal infection rate of patients with AML undergoing induction or reinduction chemotherapy.”

Amy L. Morris, of the University of Virginia Health System, is the corresponding author for the Journal of Oncology Practice article.

Disclosure: The study authors’ full disclosures may be found at jop.ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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