Invasive Aspergillosis in Acute Leukemia: Correlation with Nose Cultures and Antibiotic Use

Abstract

Aspergillosis in cancer patients is a problem. Because not all patients can undergo invasive procedures, other methods for diagnosis were sought. The data from all patients with acute nonlymphocytic leukemia treated at a center during a 3 yr period were evaluated. Of 125 patients, 18 had invasive aspergillosis (cases). Eleven patients had nose cultures growing Aspergillus flavus or A. fumigatus; 10 of these 11 had aspergillosis, whereas only 8 of 114 without such nose cultures had invasive disease (P < 0.000001). A. flavus on nose culture appears predictive for aspergillosis. Absence of such a culture does not preclude infection. Of 125 patients, 61 had sterile nose culture(s) and 14 of the 18 cases had such a sterile nose culture. Only 4 of the 64 patients without sterile nose cultures developed aspergillosis (P < 0.008), suggesting a relation between sterile nose culture and aspergillosis. Carbenicillin was used for a longer period among cases and patients with predictive nose cultures than among among patients without aspergillosis. These data may help identify patients at risk of aspergillosis and help determine antifungal therapy when invasive procedures are contraindicated.