Retrospective evaluation of antifungal treatment responses in patients with febrile neutropenia

Objective: The primary objective of this study was to formulate treatment strategies through a comprehensive analysis of episodes involving febrile neutropenic patients admitted to the Hematology Clinic of Karadeniz Technical University Farabi Hospital. This investigation encompased the examination of fungal agents isolated within our institution, the documentation rates of clinical and laboratory aspects pertaining to fungal infections, the assessment of response to antifungal treatment, and the scrutiny of the influence of fungal infections on mortality. Materials and Methods: In this retrospective study, we analyzed 156 hospital episodes involving 128 patients aged 18 years or older, characterized by an absolute neutrophil count <500/mm3. This patients received inpatient treatment at the hematology service of KTU Medical Faculty Farabi Hospital between 01/10/2016 and 30/10/2021. The focus of analysis was on individuals who underwent antifungal prophylaxis and subsequently transitioned to antifungal treatment. The study encompassed an assessment of demographic characteristics, primary disease diagnosis, treatment outcomes, neutropenia processes, fungal infection diagnosis, treatment processes, and the consequential impact on mortality. Findings: Mortality occurred in 29 (18.6%) out of 128 patients included in the analysis of 156 hospitalization episodes. Upon examining the causes of mortality, infectious factors accounted for 75.8% of cases. Acute Myeloid Leukemia (AML) was the most prevelant primary disease, constituting 66.7% of cases. The mean neutrophil count at the initiation of antifungal treatment was 497.9 ± 2590.3/mm³ for all patients. Mortality rates were higher among patients with low-risk hematology malignancies ( p = 0.010). Among the 156 hospitalization analyzed, 85 (54.4%) involved newly diagnosed patients, and mortality was notably higher in the relapsed/refractory group (p=0.017). The impact of AML and Acute Lymphoblastic Leukemia (ALL) risk groups, as well as the Multinational Association for Supportive Care in Cancer (MASCC) score on mortality could not be conclusively determined. A significant relationship was observed between the elevation of C-reactive Protein (CRP) and procalcitonin levels and mortality (p=0.001, p<0.001, respectively). The influence of empirical or preemptive antifungal treatments on mortality did not recah statistical significant. The lung was identified as the most common infection site, with Candida species being most frequently isolated pathogen. Notably, the presence of galactomannan positivity and High-Resolution Computed Tomography (HRCT) findings had a significant impact on mortality (p=0.002, p=0.001, respectively). Galactomannan positivity was noted in 64% of patients with Invasive Fungal Infection (IFI) finding (p<0.001). Amphotericin-B was the most commony initiated treatment, and the primary reason for the treatment modifications was the occurence of advers events. Results: Significant associations were observed among the primary disease of febrile neutropenic patients, particularly those diagnosed with hematologic malignancies, the specific treatments administered for their primary conditions, galactomannan positivity, as well as levels of CRP and procalcitonin. The presence of persistent fever in patients with febrile neutropenia does not uniformly indicate a fungal infection. The complexities of fungal infection in febril neutropenic patients necessiate a comprehensive evaluation that integrates factors such as fever, CRP, and procalcitonin biomarkers, along with the documentation of potential infection and the isolation of causative agents. This multifaced approach is essential for a thorough understanding and management of fungal infections in this patient population. Keywords: Febrile neutropenia, hematological malignancy, invasive fungal infections, empiric antifungal therapy, galactomannan, preemptive antifungal therapy