Anti-mold prophylaxis may reduce the risk of invasive fusariosis in hematologic patients with superficial skin lesions with positive culture forFusarium
Hematologic patients with superficial skin lesions on admission growingFusariumspp. are at high risk to develop invasive fusariosis during neutropenia. We evaluated the impact of primary prophylaxis with a mold-active azole in preventing the occurrence of invasive fusariosis in these patients. From August 2008 to December 2014, patients with acute leukemia, aplastic anemia, or recipients of hematopoietic cell transplantation were screened on admission with dermatologic examination and direct exam and fungal culture of superficial skin lesions. Until November 2009, no intervention was made. Beginning in December 2009, patients with baseline skin lesions with direct exam and/or culture suggestive of the presence ofFusariumspp. received prophylaxis with voriconazole or posaconazole. Skin lesions in the extremities (mostly onychomycosis and interdigital intertrigo) were present on admission in 88 of 239 episodes (36.8%); 44 had hyaline septate hyphae on direct exam, and 11 grewFusariumspp. Anti-mold prophylaxis was given in 20 episodes (voriconazole in 17 and posaconazole in 3). Invasive fusariosis was diagnosed in 14 episodes (5.8%). Among patients with baseline skin lesions with positive culture forFusariumspp., 4 of 5 without anti-mold prophylaxis developed invasive fusariosis vs. none of 6 with anti-mold prophylaxis (p=0.01, 95% confidence interval for the difference between proportions 22% - 96%). Primary antifungal prophylaxis with an anti-mold azole may prevent the occurrence of invasive fusariosis in high-risk hematologic patients with superficial skin lesions on admission growingFusariumspp.