Rate, Risk Factors, and Outcomes of Invasive Fungal Infections in Patients with Hematologic Malignancies

Area of Science:

• Medical Mycology
• Hematology
• Infectious Diseases

Background:

• Invasive fungal infections (IFIs) pose a significant threat to patients with hematological malignancies (HM), contributing to high mortality and morbidity.
• Understanding the epidemiology, risk factors, and outcomes of IFIs in HM patients is crucial for optimizing antifungal treatment strategies and improving patient care.
• Accurate diagnosis and targeted therapy can reduce the financial burden and life costs associated with these severe infections.

Purpose of the Study:

• To determine the incidence, causative agents, and clinical characteristics of IFIs in patients with hematological malignancies.
• To identify the primary risk factors and complications associated with IFIs in this vulnerable patient population.
• To analyze the attributable mortality rate and factors influencing patient outcomes.

Main Methods:

• A prospective cross-sectional study was conducted from January to June 2019, including patients with hematological malignancies admitted to Dr. Shariati Hospital.
• Patients with probable or proven IFIs, according to the EORTC/MSG criteria, were enrolled.
• Demographic and clinical data were collected using a questionnaire, and statistical analysis was performed using SPSS version 24.

Main Results:

• Out of 1109 HM patients, 67 (6.04%) were diagnosed with IFIs. Aspergillosis accounted for 85.04% of cases, followed by mucormycosis (10.4%).
• The mean age of IFI patients was 43.16 years, with males comprising 67.2%. Acute myeloid leukemia (AML) was the most common malignancy.
• Pulmonary lesions were observed in 77.6% of cases, and sinus involvement in 68.6%. The attributable mortality rate for IFIs was 62.7%. Central venous catheter, mucositis, and antibiotic use were identified as frequent risk factors.

Conclusions:

• Invasive fungal infections are a frequent and often fatal complication in patients with hematological malignancies.
• Aspergillus species are the predominant fungal pathogens in this patient group.
• The presence of warning signs in the sinus and lungs, unresponsive to antibiotics, should prompt consideration of IFIs in high-risk HM patients.