Improved outcome in central nervous system aspergillosis, using voriconazole treatment

被引:267
作者
Schwartz, S
Ruhnke, M
Ribaud, P
Corey, L
Driscoll, T
Cornely, OA
Schuler, U
Lutsar, I
Troke, P
Thiel, E
机构
[1] Free Univ Berlin, Med Klin 3, D-1000 Berlin, Germany
[2] Humboldt Univ, Med Klin & Poliklin 2, Berlin, Germany
[3] Hop St Louis, Paris, France
[4] Fred Hutchinson Canc Res Ctr, Program Infect Dis, Seattle, WA 98104 USA
[5] Duke Univ, Med Ctr, Div Hematol Oncol, Durham, NC USA
[6] Klinikum Univ Koln, Innere Med Klin 1, Cologne, Germany
[7] Univ Klinikum Carl Gustav Carus, Med Klin 1, Dresden, Germany
[8] Univ Tartu, Inst Microbiol, EE-50090 Tartu, Estonia
[9] Pfizer Global Res, Sandwich, Kent, England
关键词
D O I
10.1182/blood-2005-02-0733
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The mortality of central nervous system (CNS) aspergillosis approaches 100%, requiring improved therapies. Voriconazole gives superior efficacy and survival in invasive aspergillosis, compared with amphotericin B. Also, in contrast to other antifungal drugs, voriconazole penetrates well into the CNS. We evaluated, retrospectively, the outcome and survival of 81 patients who were treated with voriconazole for definite (n = 48) or probable (n = 33) CNS aspergillosis. Complete and partial responses were recorded in 35% of patients and varied by the underlying disease group: hematologic malignancies (54%), other underlying conditions (50%), chronic immunosuppression (45%), solid organ transplantation (36%), and hematopoietic stem cell transplantation (16%). Thirty-one percent of patients survived CNS aspergillosis for a median observation time of 390 days. There were 31 patients who underwent neurosurgical procedures, including craniotomy/abscess resection (n = 14), abscess drainage (n = 12), ventricular shunt (n = 4), and Ommaya-reservoir (n = 1). Multifactorial analysis revealed that neurosurgery was associated with improved survival (P = .02). Patients who underwent hematopoietic stem cell transplantation had a poorer survival (P = .02), but 7 (22%) of 32 survived for a median of 203 days. We conclude from this large cohort of patients that voriconazole treatment together with neurosurgical management, whenever feasible, is currently the best approach to treat patients with CNS aspergillosis.
引用
收藏
页码:2641 / 2645
页数:5
相关论文
共 27 条
[1]   Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: An international consensus [J].
Ascioglu, S ;
Rex, JH ;
de Pauw, B ;
Bennett, JE ;
Bille, J ;
Crokaert, F ;
Denning, DW ;
Donnelly, JP ;
Edwards, JE ;
Erjavec, Z ;
Fiere, D ;
Lortholary, O ;
Maertens, J ;
Meis, JF ;
Patterson, TF ;
Ritter, J ;
Selleslag, D ;
Shah, PM ;
Stevens, DA ;
Walsh, TJ .
CLINICAL INFECTIOUS DISEASES, 2002, 34 (01) :7-14
[2]   FUNGAL-INFECTIONS IN CANCER-PATIENTS - AN INTERNATIONAL AUTOPSY SURVEY [J].
BODEY, G ;
BUELTMANN, B ;
DUGUID, W ;
GIBBS, D ;
HANAK, H ;
HOTCHI, M ;
MALL, G ;
MARTINO, P ;
MEUNIER, F ;
MILLIKEN, S ;
NAOE, S ;
OKUDAIRA, M ;
SCEVOLA, D ;
VANTWOUT, J .
EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, 1992, 11 (02) :99-109
[3]  
CLEMONS KV, 2004, 44 INT C ANT AG CHEM, P424
[4]  
COLEMAN JM, 1995, NEUROSURGERY, V36, P858, DOI 10.1097/00006123-199504000-00032
[5]   TISSUE DISTRIBUTION AND BIOACTIVITY OF AMPHOTERICIN-B ADMINISTERED IN LIPOSOMES TO CANCER-PATIENTS [J].
COLLETTE, N ;
VANDERAUWERA, P ;
MEUNIER, F ;
LAMBERT, C ;
SCULIER, JP ;
COUNE, A .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 1991, 27 (04) :535-548
[6]   TISSUE CONCENTRATIONS AND BIOACTIVITY OF AMPHOTERICIN-B IN CANCER-PATIENTS TREATED WITH AMPHOTERICIN-B-DEOXYCHOLATE [J].
COLLETTE, N ;
VANDERAUWERA, P ;
LOPEZ, AP ;
HEYMANS, C ;
MEUNIER, F .
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 1989, 33 (03) :362-368
[7]   Efficacy and safety of voriconazole in the treatment of acute invasive aspergillosis [J].
Denning, DW ;
Ribaud, P ;
Milpied, N ;
Caillot, D ;
Herbrecht, R ;
Thiel, E ;
Haas, A ;
Ruhnke, M ;
Lode, H .
CLINICAL INFECTIOUS DISEASES, 2002, 34 (05) :563-571
[8]   Therapeutic outcome in invasive aspergillosis [J].
Denning, DW .
CLINICAL INFECTIOUS DISEASES, 1996, 23 (03) :608-615
[9]   In vitro antifungal activities of voriconazole and reference agents as determined by NCCLS methods: Review of the literature [J].
Espinel-Ingroff, A ;
Boyle, K ;
Sheehan, DJ .
MYCOPATHOLOGIA, 2001, 150 (03) :101-115
[10]   BRAIN-ABSCESS FOLLOWING MARROW TRANSPLANTATION - EXPERIENCE AT THE FRED-HUTCHINSON-CANCER-RESEARCH-CENTER, 1984-1992 [J].
HAGENSEE, ME ;
BAUWENS, JE ;
KJOS, B ;
BOWDEN, RA .
CLINICAL INFECTIOUS DISEASES, 1994, 19 (03) :402-408