Evaluation of Empirical Antifungal Treatments in Patients with Neutropenic Fever in Imam Hossein Hospital, Tehran, 2017 - 2018

Background: Invasive fungal infections are among the most important causes of death in patients with neutropenic fever. Early detection of the cause of neutropenia and appropriate treatment, including experimental antifungal therapy, plays a key role in reducing mortality and cutting financial costs for the individual and society. Methods: In this retrospective study, the records of 33 patients with fever and neutropenia who received antifungal drugs (including Amphotericin B, Voriconazole, Caspofungin, and Fluconazole) were evaluated. Neutropenia was defined as episodes of fever (axillary temperature > 38.2°C or oral temperature > 37.7°C) and neutrophil count < 500 /μL persistent for five days despite antibacterial therapy without an infectious etiology. For statistical analysis, SPSS software version 21 was used. Results: In this study, out of 33 neutropenic patients receiving antifungal therapy, a fungal agent was defined in 19 patients (59%). Mucor species was the most common cause of fungal infections, followed by aspergillus and candida. Liposomal Amphotericin B and Caspofungin were the most common antifungal agents used for treating patients with neutropenic fever. Antifungal therapy in neutropenic patients resulted in 50% recovery and 50% mortality. Statistical analysis showed that neutropenic patients did not have a significant difference in response to treatments based on age groups and gender. Conclusions: The study highlights the importance of experimental therapy in neutropenic patients based on clinical criteria and risk factors, and with a diagnostic approach, rather than general treatment.