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L'Hermite de la Guiane, ou Observations sur les moeurs et les usages français au commencement du XIXe siècle. Tome deuxième
Auteur(s) : Jouy, Étienne de (1764-1846)
Année de publication :

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Indications and outcomes of antifungal therapy in French patients with haematological conditions or recipients of haematopoietic stem cell transplantation.
Auteur(s) : Herbrecht, Raoul Caillot, Denis Cordonnier, Catherine Auvrignon, Anne Thiébaut, Anne Brethon, Benoît Michallet, Mauricette Mahlaoui, Nizar
Auteurs secondaires : Service d'Hématologie ; CHU Strasbourg Hôpital du Bocage ; Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon) Service d'hématologie clinique ; Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Henri Mondor - Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12) CHU Trousseau [APHP] Service d'hématologie [Lyon] ; Hospices Civils de Lyon - Hôpital Edouard Herriot IFR Necker-Enfants Malades (IRNEM) ; Assistance publique - Hôpitaux de Paris (AP-HP) - Université Paris Descartes - Paris 5 (UPD5) - Institut National de la Santé et de la Recherche Médicale (INSERM) - Centre National de la Recherche Scientifique (CNRS) Hématologie et immunologie pédiatrique ; Hospices Civils de Lyon - CHU Lyon - Institut d'Hématologie et d'Oncologie Pédiatrique (IHOP) - Hôpital Femme-Mère-Enfant (HFME) Service d'hématologie clinique et de thérapie cellulaire [CHU Saint-Antoine] ; Assistance publique - Hôpitaux de Paris (AP-HP) - CHU Saint-Antoine [APHP]

Éditeur(s) : HAL CCSD Oxford University Press (OUP)
Résumé : International audience
OBJECTIVES: Invasive fungal disease (IFD) remains a major concern in patients with haematological conditions. We describe diagnoses, therapeutic management and outcomes in unselected consecutive patients from haematological facilities treated for suspected or documented IFD. METHODS: In this observational prospective study, children/adults with haematological conditions or haematopoietic stem cell transplantation (HSCT) were recruited upon start of non-prophylactic systemic antifungal treatment in 37 French haematological facilities (December 2007 to December 2008). IFD episodes were classified according to the 2008 EORTC/MSG criteria. RESULTS: The cohort included 419 patients (298 adults and 121 children): 88% haematological malignancies, 28% HSCT recipients and 68% neutropenic. Patients had 423 IFD episodes: 21% mycologically documented (59% probable/proven aspergillosis, 32% proven candidiasis and 9% probable/proven other IFD) and 20% classified as possible IFD. The remaining cases were assigned to two groups: febrile neutropenia (34%) and unclassified (25%), 9% of which were classified as possible/probable/proven IFD by day 7. Treatment was thus initiated early in 59% of patients; liposomal amphotericin B and caspofungin were the most common single-agent therapies. The 12 week mortality was 18% for probable/proven aspergillosis, 15% for proven candidiasis, 10% for probable/proven other IFD, 9% for possible IFD, 3% for febrile neutropenia and 12% for unclassified episodes (log rank P = 0.016); it was dependent on age, complete remission of underlying haematological disease and mechanical ventilation. CONCLUSIONS: In this comprehensive sample of haematological patients receiving antifungal treatment, we observe a widespread resort to early therapy and a low mortality rate, including in patients with probable or proven IFD.
ISSN: 0305-7453

hal-00874741
https://hal.archives-ouvertes.fr/hal-00874741
DOI : 10.1093/jac/dks266
PUBMED : 22850692

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