OBJECTIVES: To describe changes in outcomes, treatment patterns and costs of the management of hospitalized patients with acute AML after chemotherapy in Germany over a 3-year time horizon, with a special focus on prophylaxis and treatment of invasive fungal infections (IFI). METHODS: This was a retrospective, single centre study on AML patients hospitalized for chemotherapy, neutropenia and infections after myelosuppressive chemotherapy from January 2004 to December 2006. Data on occurrence of IFI, treatment patterns and resource utilization were collected by chart review. Direct medical costs were calculated from hospital provider perspective. RESULTS: In total, 471 hospitalization episodes in 212 patients were eligible for analysis. Occurrence of IFI decreased from 5.9% in 2004 to 1.9% in 2006. Mean hospital stay decreased from 28.7±17.9 days (2004) to 22.4±11.8 days (2006) (p<0.05). From 2004 to 2006, use of a single antifungal drug increased from 30.4% to 46.9% of episodes, whereas use of multiple antifungal drugs decreased from 24.4% to 13.1%. Single antifungal drug use was dominated by azoles and increased from 23.7% (2004) to 43.4% of episodes (2006). Posaconzole monotherapy was applied in 26.7% of episodes. Use of liposomal amphotericin B declined from 21.4% to 3.8%, caspofungin from 19.3% to 8.1%, fluconazole from 25.2% to 11.9%, and voriconazole from 31.9% to 15.0%. Total costs per episode declined from €19,051±19,024 (2004) to €13,531±9,260 (2006) (p<0.05); main reduction was observed for antimycotics, blood products and hospital stay. CONCLUSIONS: These real-life data from a university hospital in Germany indicate that the antifungal management of AML patient hospitalized for chemotherapy, neutropenia and infections after chemotherapy changed between 2004/5 and 2006. This change was accompanied by a decline in treatment costs. Results suggest that the introduction of posaconazole prophylaxis in 2006 has not only reduced the use of antifungal therapies but also the need for treatment with multiple antifungal drugs.