Characterisation of Antifungal Prophylaxis and Therapy Among Inpatients With Haematological Malignancies in Non-Research Clinical Setting: A Multicentre Italian Experience

Background: Invasive fungal infections (IFI) are a prominent cause of morbidity and mortality among patients with haematological malignancies (HMs). Diagnostic work-up excluding IFI is mandatory in case of persistent fever while antifungal treatment (AFT) is started. Objectives: We aimed to describe antifungal prophylaxis (AFP) and AFT among haematological patients with IFI managed in clinical practice, focusing on microbiological and radiological characteristics, 30-day outcome and therapeutic options after AFT failure. Patients and Methods: We enrolled 461 consecutive adult and paediatric patients with HMs, in which an intravenous AFT was started from September 2019 to December 2021. After serum galactomannan (GM) and chest CT scan, they were stratified as presenting with proven, probable, and possible IFI according to 2008 EORTC-MSG criteria. Fungal isolates were detected from culture tests in 17.5% and from biopsy in 1.5% of patients. Mould active and non-active AFP was used in 42.3% and 16.5% of cases, respectively. Results: Use of AFP significantly impact on serum GM negativity (p < 0.001 for mould active and p = 0.04 for mould non active, respectively). Use of mould non-active prophylaxis significantly correlates with radiological imaging (typical p = 0.0037, IC (0.370–0.825) and negative -p = 0.0031, IC (0.241–0.750)). Toxicity, progression, and drug interaction were responsible for therapy change in 58 (12%) patients: 18 patients with proven/probable IFI needed multiple courses of AFT. At 30 days from starting AFT, overall mortality with IFI was 23/461 (5%). Conclusions: In this observational study, we recorded an impact of AFP on serum GM results and radiological imaging. Need of AFT should be carefully evaluated, as diagnostic work-up might be affected not only by specific disease risk but also by previous AFP.