Invasive and surgical procedures
Major surgery (including intra-abdominal), organ transplantation, life support measures (including mechanical ventilation), or insertion of medical devices (including shunts, catheters and total parenteral nutrition).2 Multiple invasive procedures and prolonged stay in ICU can also increase risk.2,12
Every day that an IFI goes untreated reduces the chance of survival.16,17 Timely diagnosis can be affected by many different factors:
The lack of definitive disease confirmation can delay treatment for patients. Appropriate antifungal treatment should be administered as soon as an IFI is suspected.17,19
Using revised EORTC/MSG definitions, a post-hoc analysis found that initiating AmBisome® (3 mg/kg/day) at the point of suspicion of an IFI (based on pulmonary scan) significantly improved response rates (p=0.006) vs. treating a probable or proven IFI.23
Think IFI particularly in patients presenting with fever, who have not responded to broad-spectrum antibiotics.22
Identify your at-risk patients early by looking out for the specific risk factors.
Prompt initiation of appropriate broad-spectrum antifungal treatment, even in the absence of a confirmed diagnosis, may reduce mortality risk.1,13,16,17,24-26
*Recommended by the IDSA guidelines for the management of suspected candidiasis (strong recommendation, moderate-quality evidence) and suspected aspergillosis (strong recommendation, high-quality evidence) in febrile, neutropenic patients and ESCMID-ECMM-ERS guidelines (grading BI).
**Reanalysis of data from the AmBiLoad study - a double-blind study in 339 immunocompromised adults and children with proven or probable invasive aspergillosis or other mould infections (EORTC/MSG criteria) who were randomised (1:1) to receive 1st-line therapy with AmBisome® 3 mg/kg/day or a loading dose of 10 mg/kg/day for the first 14 days and then the standard dose.23,27
†AmBisome® is indicated for the empirical treatment of presumed fungal infections in febrile neutropenic patients, where the fever has failed to respond to broad spectrum antibiotics and appropriate investigations have failed to define a bacterial or viral cause.22
Date of preparation: April 2022. Job code: IHQ-AMB-0430.