Fungal surveillance cultures during antifungal prophylaxis with itraconazole in neutropenic patients with acute leukaemia

Fungal colonization has been associated with an increased rate of invasive fungal infections in neutropenic patients. This study evaluates weekly fung al surveillance cultures from the oropharyngeal and perianal space as well as other suspected sites in 219 courses of myelosuppressive chemotherapy wi th itraconazole antifungal prophylaxis in 116 neutropenic patients with acu te leukaemia. Itraconazole was given from the start of chemotherapy in one of six different dosing regimens. Fungal colonization occurred in 68 (31%) of courses, which was lower than in a historical control group without prop hylaxis (53%, P=0.004). Twenty-six per cent of these 116 isolates had a gro wth rate of more than 50 colony forming units (CFU) per culture. Candida gl abrata (51%), Candida albicans (18%) and Candida krusei (4%) were the most frequently isolated species. Higher median itraconazole trough concentratio ns were associated with a lower growth rate in the cultures (less than or e qual to 50 CFU/culture versus>50 CFU/culture): 710 (430-1180) ng ml(-1) ver sus 900 (560-1650) ng ml(-1) (P=0.015). The use of itraconazole solution-co mpared with capsules-led to a reduced growth rate (P=0.035). In conclusion, compared with historical controls itraconazole antifungal prophylaxis redu ces the incidence and the extent of fungal colonization during neutropenia in patients with acute leukaemia.