430Patients with Prolonged (>10 days) Neutropenia Displayed Similar IFI Rates Regardless of Hematologic Diagnosis and Chemotherapy Status: A Challenge to Antifungal Prophylaxis Decisions

Background. Invasive fungal infections (IFI) are a significant source of morbidity and mortality in neutropenic patients. Risk based prophylaxis or pre-emptive therapy are debated clinical approaches. Since 2009, IPC at our tertiary care institution has collected the IFI rate per 1,000 neutropenic patient days. We examine IFI per neutropenic episode by patient characterictics and duration of neutropenia. Methods. All neutropenic Hematology ward patients were assessed, those with ANC of 0.5 x 10/L or less for >10 days were followed prospectively for development of Probable or Definite IFI by the 2008 EORTC criteria. Chart data were collected: demographics, hematologic diagnosis, type of chemotherapeutic regimen, and neutropenic days (NDS), and if an IFI was diagnosed; the fungus, site of culture, and outcome. Results. There were 277 neutropenic episodes in 180 patients, (mean 26 NDs) identified from January 2009 to December 2010. ‘Severe’ criteria was met in 177 episodes (63.9%) in 116 patients (mean 37.8 NDs). Twenty (17.2%) of these had IFI with 6 (30%) related deaths. IFI case patients (21 IFIs) had a mean of 43.9 NDs per episode (4-148 days) . There were 6 cases of aspergillosis, 14 candidiasis, and 1 fungus that failed to grow but resembled coccidiomycosis.