***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objective : To evaluate the cost-effectiveness of caspofungin versus liposomal amphotericin B ( L-AmB ) for empirical antifungal therapy in patients with persistent fever and neutropenia in Sweden . Methods : With a decision-analytic model , the expected direct costs , life-years lost and quality adjusted life-years lost were estimated for an average patient in Sweden .  Efficacy/tolerability data were obtained from analysis of a r and omized , double-blind multinational trial . Life expectancy , medical re source use and unit costs data were gathered from the literature and expert opinion . Probabilistic sensitivity analysis was used to evaluate the impact of uncertainty in data on outcomes . Results : The direct cost with caspofungin amounted to 233,851 SEK ( 95 % uncertainty interval 225,091–242,210 ) and with L-AmB to 271,921 SEK ( 262,935–281,363 ) , a difference of 38,070 SEK ( 31,745–44,811 ) favouring caspofungin . Treatment with caspofungin result ed in 0.25 ( 0.01–0.55 ) quality -adjusted life-years ( QALYs ) saved in comparison to L-AmB. Given the uncertainty in the estimates there is a > 95 % probability that caspofungin is economically dominant over L-AmB , i.e. cost-saving and QALY-saving . Conclusion : Given the underlying assumptions and data used , caspofungin is expected to be cost-effective with at least comparable outcomes compared to L-AmB for the empirical treatment of patients with suspected fungal infections in Sweden Given that the rationale for empirical antifungal therapy in neutropenic children is limited and based on adult patient data , we performed a prospect i ve , r and omized , controlled trial that evaluated 110 neutropenic children with persistent fever . Those at high risk for invasive fungal infections ( IFI ) received caspofungin ( Arm C ) or liposomal amphotericinB ( Arm B ) ; those with a lower risk were r and omized to receive Arm B , C , or no antifungal treatment ( Arm A ) . Complete response to empirical antifungal therapy was achieved in 90/104 patients ( 86·5 % ) : 48/56 at high risk ( 85·7 % ) [ 88·0 % in Arm B ; 83·9 % in Arm C ( P = 0·72 ) ] , and 42/48 at low risk ( 87·5 % ) [ 87·5 % in control Arm A , 80·0 % Arm B , 94·1 % Arm C ; ( P = 0·41 ) ] . None of the variables tested by multiple logistic regression analysis showed a significant effect on the probability to achieve complete response . IFI was diagnosed in nine patients ( 8·2 % , 95 % confidence interval , 3·8–15·0 ) . This r and omized controlled study showed that empirical antifungal therapy was of no advantage in terms of survival without fever and IFI in patients aged < 18 years and defined with low risk of IFI . Higher risk patients , including those with relapsed cancer , appear to be the target for empirical antifungal therapy during protracted febrile neutropenia In 2005 , several groups , including the European Group for Blood and Marrow Transplantation , the European Organization for Treatment and Research of Cancer , the European Leukemia Net and the Immunocompromised Host Society created the European Conference on Infections in Leukemia ( ECIL ) . The main goal of ECIL is to elaborate guidelines , or recommendations , for the management of infections in leukemia and stem cell transplant patients . The first sets of ECIL slides about the management of invasive fungal disease were made available on the web in 2006 and the papers were published in 2007 . The third meeting of the group ( ECIL 3 ) was held in September 2009 and the group up date d its previous recommendations . The goal of this paper is to summarize the new proposals from ECIL 3 , based on the results of studies published after the ECIL 2 meeting : ( 1 ) the prophylactic recommendations for hematopoietic stem cell transplant recipients were formulated differently , by splitting the neutropenic and the GVHD phases and taking into account recent data on voriconazole ; ( 2 ) micafungin was introduced as an alternative drug for empirical antifungal therapy ; ( 3 ) although several studies were published on preemptive antifungal approaches in neutropenic patients , the group decided not to propose any recommendation , as the only r and omized study comparing an empirical versus a preemptive approach showed a significant excess of fungal disease in the preemptive group OBJECTIVE To evaluate the cost-effectiveness of caspofungin versus liposomal amphotericin B as empiric antifungal treatment in patients with neutropenic fever in Italy . METHODS The cost-effectiveness of caspofungin versus liposomal amphotericin B was evaluated using a decision-tree model . Patients were stratified by presence or absence of baseline infection . Model outcomes included success in terms of resolution of fever , resolution of baseline infection , absence of breakthrough infection , survival , and quality -adjusted life years ( QALYs ) saved . Discontinuation because of nephrotoxicity or other adverse events were included in the model . Efficacy and safety data were based on a r and omized , double-blind , multinational trial of caspofungin compared to liposomal amphotericin B ( Walsh 2004 ) . Information on life expectancy , quality of life , medical re source consumption , and costs was obtained from the literature . RESULTS The caspofungin estimated total treatment cost amounted to 8351 euros ( 95 % uncertainty interval 7801 euros-8903 euros ) , which is 3470 euros ( 2575 euros-4382 euros ) less than with liposomal amphotericin B. Treatment with caspofungin result ed in 0.25 ( -0.11 ; 0.59 ) QALYs saved in comparison to treatment with liposomal amphotericin B. Probabilistic sensitivity analysis demonstrated a 93 % probability that caspofungin was economically dominant , i.e. , cost and QALY saving , and a probability of more than 99 % that the costs per QALY saved were below 20,000 euros , a commonly accepted threshold for cost-effectiveness . Additional analyses with alternative doses of liposomal amphotericin B confirmed these findings . CONCLUSION Given the underlying assumptions , our economic evaluation demonstrated that caspofungin is cost-effective compared to liposomal amphotericin B in empiric antifungal treatment of patients with neutropenic fever in Italy Micafungin , a clinical ly important echinoc and in antifungal drug , needs to be investigated as empirical therapy in febrile neutropenia in comparison with azole compounds . A prospect i ve r and omized study was conducted to compare clinical outcomes between micafungin and intravenous itraconazole as an empirical therapy for febrile neutropenia in hematological malignancies . The antifungal drug ( micafungin 100 mg or itraconazole 200 mg IV once daily ) was given for high fever that was sustained despite the administration of appropriate antibiotics . Treatment success was determined by composite end points based on breakthrough invasive fungal infection ( IFI ) , survival , premature discontinuation , defervescence , and treatment of baseline fungal infection . Duration of fever , hospital stay , and overall survival ( OS ) were studied . A total of 153 patients were r and omized to receive micafungin or itraconazole . The overall success rate was 7.1 % point higher in the micafungin group ( 64.4 vs. 57.3 % , p = 0.404 ) , satisfying the statistical criteria for the non-inferiority of micafungin . The duration of fever and hospital stay were significantly shorter in the micafungin group ( 6 vs. 7 days , p = 0.014 ; 22 vs. 27 days , p = 0.033 , respectively ) . Grade 3 adverse events including hyperbilirubinemia ( 2 vs. 7 ) , elevation of transaminase levels ( 2 vs. 4 ) , electrolyte imbalance ( 1 vs. 2 ) , atrial fibrillation ( 1 vs. 0 ) , and anaphylaxis ( 1 vs. 0 ) occurred in 7 and 13 patients in the micafungin ( 10.4 % ) and itraconazole ( 18.8 % ) groups , respectively . Micafungin , when compared with itraconazole , had favorably comparable success rate and toxicity profiles on febrile neutropenia in patients with hematological malignancies . In addition , it showed superior effect on shortening the hospital stay BACKGROUND Patients with neutropenia and persistent fever are often treated empirically with amphotericin B or liposomal amphotericin B to prevent invasive fungal infections . Antifungal triazoles offer a potentially safer and effective alternative . METHODS In a r and omized , international , multicenter trial , we compared voriconazole , a new second-generation triazole , with liposomal amphotericin B for empirical antifungal therapy . RESULTS A total of 837 patients ( 415 assigned to voriconazole and 422 to liposomal amphotericin B ) were evaluated for success of treatment . The overall success rates were 26.0 percent with voriconazole and 30.6 percent with liposomal amphotericin B ( 95 percent confidence interval for the difference , -10.6 to 1.6 percentage points ) ; these rates were independent of the administration of antifungal prophylaxis or the use of colony-stimulating factors . There were fewer documented breakthrough fungal infections in patients treated with voriconazole than in those treated with liposomal amphotericin B ( 8 [ 1.9 percent ] vs. 21 [ 5.0 percent ] , P=0.02 ) . The voriconazole group had fewer cases of severe infusion-related reactions ( P<0.01 ) and of nephrotoxicity ( P<0.001 ) . The incidence of hepatotoxicity was similar in the two groups . Patients receiving voriconazole had more episodes of transient visual changes than those receiving liposomal amphotericin B ( 22 percent vs. 1 percent , P<0.001 ) and more hallucinations ( 4.3 percent vs. 0.5 percent , P<0.001 ) . Parenteral voriconazole was changed to the oral formulation in 22 percent of the voriconazole group , with a reduction in the mean duration of hospitalization by one day in all patients ( P=0.17 ) but by two days in patients at high risk ( P=0.03 ) . CONCLUSIONS Voriconazole is a suitable alternative to amphotericin B preparations for empirical antifungal therapy in patients with neutropenia and persistent fever BACKGROUND With use of data from the Prospect i ve Antifungal Therapy ( PATH ) Alliance registry , we performed this multicenter , prospect i ve , observational study to assess the epidemiologic characters and outcomes of invasive fungal infection ( IFI ) in hematopoietic stem cell transplant ( HSCT ) recipients . METHODS Sixteen medical centers from North America reported data on adult HSCT recipients with proven or probable IFI during the period July 2004 through September 2007 . The distribution of IFIs and rates of survival at 6 and 12 weeks after diagnosis were studied . We used logistic regression models to determine risk factors associated with 6-week mortality for allogeneic HSCT recipients with invasive aspergillosis ( IA ) . RESULTS Two hundred thirty-four adult HSCT recipients with a total of 250 IFIs were included in this study . IA ( 59.2 % ) was the most frequent IFI , followed by invasive c and idiasis ( 24.8 % ) , zygomycosis ( 7.2 % ) , and IFI due to other molds ( 6.8 % ) . Voriconazole was the most frequently administered agent ( 68.4 % ) ; amphotericin B deoxycholate was administered to a few patients ( 2.1 % ) . Ninety-three ( 46.7 % ) of 199 HSCT recipients with known outcome had died by week 12 . The 6-week survival rate was significantly greater for patients with IA than for those with invasive c and idiasis and for those with IFI due to the Zygomycetes or other molds ( P < .07 ) . The 6-week mortality rate for HSCT recipients with IA was 21.5 % . At 6 weeks , there was a trend toward a worse outcome among allogeneic HSCT recipients with IA who received myeloablative conditioning ( P = .07 ) ; absence of mechanical ventilation or/ and hemodialysis ( P = .01 ) were associated with improved survival . CONCLUSIONS IA remains the most commonly identified IFI among HSCT recipients , but rates of survival in persons with IA appear to have improved , compared with previously reported data . Invasive c and idiasis and IFI due to molds other than Aspergillus species remain a significant problem in HSCT recipients The safety and efficacy profile of caspofungin and micafungin in Japanese patients with fungal infections were directly compared in this prospect i ve , r and omized , double-blind study . The proportion of patients who 
    Output:
    
Other differences in outcomes among antifungals were not statistically significant .
From the rank probability plot , caspofungin appeared to be the most effective agent for all-cause mortality and fungal infection-related mortality , whereas micafungin tended to be superior for treatment response .
The results were stable after excluding RCTs with high risk of bias , whereas micafungin had the lowest fungal infection-related mortality .
Conclusions Our results highlighted the necessity of empiric antifungal treatment and indicates that echinoc and ins appeared to be the most effective agents for empiric treatment of febrile neutropenic patients based on mortality and treatment response .