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Diagnostic versus empirical

firm conclusions about the optimal diagnostic-driven strategy. There are currently no double-blinded placebo controlled studies in this area but this type of study would not be feasible due to ethical and practical considerations. An EORTC-led prospective study including high-risk patients and standardised antifungal treatment and prophylaxis may help to answer this question.6 In the interim, it may be helpful

for individual units to establish an algorithm for the prophylaxis and management of fungal infections based on the patient group, investigations available and experience of the multi-disciplinary team. l

References 1. De Pauw B et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008;46:1813–21.

2. Marchetti O et al. ECIL recommendations for the use of biological markers for the diagnosis of invasive fungal diseases in leukemic patients and hematopoietic SCT recipients. Bone Marrow Transplant 2012;47:846–54.

10 3. Karageorgopoulos DE et al. β-D-glucan assay for

the diagnosis of invasive fungal infections: a meta-analysis. Clin Infect Dis 2011;52:750–70.

4. Lamoth F et al. β-Glucan antigenemia assay for the diagnosis of invasive fungal infections in patients with hematological malignancies: a systematic review and meta-analysis of cohort studies from the Third European Conference on Infections in Leukemia (ECIL-3). Clin Infect Dis 2012;54:633–43.

5. Bodey GP et al. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 1966;64:328–40.

6. Cordonnier C et al. Antifungal pre-emptive strategy for high-risk neutropenic patients: why the story is still ongoing. Clin Microbiol Infect 2014;20 Suppl. 6:27–35.

7. Maertens J et al. Galactomannan and computed tomography-based preemptive antifungal therapy in neutropenic patients at high risk for invasive fungal infection: a prospective feasibility study. Clin Infect Dis. 2005;41:1242–50.

8. Dignan FL et al. An early CT-diagnosis-based treatment strategy for invasive fungal infection in allogeneic transplant recipients using caspofungin first line: an effective strategy with low mortality. Bone Marrow Transplant 2009;44:51–6.

9. Aguilar-Guisado M et al. Empirical antifungal therapy in selected patients with persistent febrile neutropenia. Bone Marrow Transplant 2010;45:159–64.

10. Girmenia C et al. Invasive fungal diseases during first induction chemotherapy affect complete remission achievement and long-term survival of patients with acute myeloid leukemia. Leuk Res 2014;38:469–74.

11. Pagano L et al. The use and efficacy of empirical versus pre-emptive therapy in the management of fungal infections: the HEMA e-Chart Project. Haematologica 2011;96:1366–70.

12. Cordonnier C et al. Empirical versus preemptive antifungal therapy for high-risk, febrile, neutropenic patients: a randomized, controlled trial. Clin Infect Dis 2009;48:1042–51.

13. Morrissey CO et al. Galactomannan and PCR versus culture and histology for directing use of antifungal treatment for invasive aspergillosis in high-risk haematology patients: a randomised controlled trial. Lancet Infect Dis 2013;13:519–28.

14. Hebart H et al. A prospective randomized controlled trial comparing PCR-based and empirical treatment with liposomal amphotericin B in patients after allo-SCT. Bone Marrow Transplant 2009;43:553–61.

15. Blennow O et al. Randomized PCR-based therapy and risk factors for invasive fungal infection following reduced-intensity conditioning and hematopoietic SCT. Bone Marrow Transplant 2010;45:1710–8.

16. Ben-Ami R et al. A multidisciplinary team approach to the management of patients with suspected or diagnosed invasive fungal disease. J Antimicrob Chemother. 2013;68 Suppl. 3:iii25–33.

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