Association between antifungal prophylaxis and rate of documented bacteremia in febrile neutropenic cancer patients

Published data have suggested a correlation between antifungal prophylaxis and bacteremia in febrile neutropenia. This correlation was investigated am ong 3002 febrile neutropenic patients enrolled in 4 trials during 1986-1994 . Globally, 1322 patients (44%) did not receive antifungal prophylaxis; 835 (28%) received poorly absorbable antifungal agents and 845 (28%) received absorbable antifungal agents. The rates of bacteremia for these groups were 20%, 26%, and 27%, respectively (P = .0001). In a multivariate model witho ut including antifungal prophylaxis, factors associated with bacteremia wer e: age, duration of hospitalization, duration of neutropenia before enrollm ent, underlying disease, presence of an intravenous catheter, shock, antiba cterial prophylaxis, temperature, and granulocyte count at onset of fever. When antifungal prophylaxis was included, the adjustment quality of the mod el improved slightly (P = .05), with an odds ratio of 1.19 (95% confidence interval [CI], 0.92- 1.55) for patients receiving nonabsorbable and 1.42 (9 5% CI, 1.07- 1.88) for those who were receiving absorbable antifungal agent s. Antifungal prophylaxis with absorbable agents might have an impact on th e rate of documented bacteremia in febrile neutropenia. This effect should be confirmed prospectively.