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Invasive mold infections in allogeneic bone marrow transplant recipients
J W Baddley1, T P Stroud, D Salzman
1Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-0006, USA. jbaddley@uab.edu
Abstract:
Invasive mold infections (IMIs) are an important cause of morbidity and mortality in patients who are undergoing bone marrow transplantation (BMT). To examine the epidemiology, risk factors, and outcome of IMIs in allogeneic BMT recipients, all cases of mold infection among 94 adult patients who underwent allogeneic BMT at this institution from 1 January 1997 through 31 December 1998 were reviewed retrospectively. Fifteen cases of IMI were identified; infection occurred a median of 102 days after BMT. Aspergillus species was the most common cause of disease, and species other than Aspergillus fumigatus were present in 53% of patients. By multivariate analysis, the variable associated with infection risk was systemic glucocorticosteroid use. Prophylactic antifungal therapy that was targeted to high-risk patients had little effect on disease incidence. These observations suggest that early identification of high-risk patients and better approaches to prevention should be explored, to reduce incidence and severity of disease in this population.
Insights
Invasive mold infections (IMIs) pose significant risks for bone marrow transplant (BMT) patients. Systemic glucocorticosteroid use was identified as a key risk factor, highlighting the need for improved prevention strategies.
Area of Science:
- Medical Mycology
- Hematology
- Transplantation Immunology
Background:
- Invasive mold infections (IMIs) are a major cause of illness and death in bone marrow transplant (BMT) recipients.
- Understanding the epidemiology and risk factors for IMIs is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the epidemiology, risk factors, and outcomes of IMIs in adult allogeneic BMT recipients.
- To identify specific pathogens and patient characteristics associated with IMI development.
Main Methods:
- Retrospective review of 15 cases of IMI among 94 adult patients undergoing allogeneic BMT between January 1997 and December 1998.
- Multivariate analysis to determine variables associated with infection risk.
Main Results:
- Fifteen cases of IMI were identified, occurring a median of 102 days post-BMT.
- Aspergillus species were the most frequent cause, with non-fumigatus species in 53% of cases.
- Systemic glucocorticosteroid use was significantly associated with increased IMI risk.
Conclusions:
- Systemic glucocorticosteroid use is a critical risk factor for IMIs in allogeneic BMT patients.
- Current prophylactic antifungal strategies showed limited impact on disease incidence.
- Further research into early identification and enhanced prevention methods for high-risk patients is warranted.
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