Antifungal Therapy for Patients with Leukemia — Are We Ready for Stewardship?

Invasive fungal infections are difficult to diagnose in patients with hematologic malignancy or after hematopoietic stem cell transplant (HSCT); moreover, these infections are often unresponsive to treatment. Patients receive prophylactic antifungals which are frequently escalated to treatment despite diagnostic uncertainty. Investigators in London queried electronic records to capture treatment courses and categorize the strength of indications among 298 patients who had undergone chemotherapy or HSCT in 2019–2022.

Among 298 patients accruing 24,074 inpatient days, 95% received mold-active antifungal prophylaxis. In all, 288 treatment episodes were recorded, including antifungal therapy for invasive fungal infection that was proven or probable (71 patients), possible (102 patients), or did not meet diagnostic criteria (115 patients). A reading of “indeterminate” for invasive fungal infection on thoracic computed tomography contributed to the initiation of antifungal therapy in patients who otherwise did not meet consensus criteria for invasive fungal infections.