Incidence and Risk Factors for Invasive Fungal Infection in Patients with Hematological Malignancies at a Tertiary...

This study aims to describe the incidence and risk factors of invasive fungal infection (IFI) among patients with haematological malignancies (HM) in a tertiary hospital from Malaysia.

This was a cross-sectional study in a teaching hospital involving HM patients, admitted for chemotherapy or haematopoietic stem cell transplantation (HSCT). Each admission for either chemotherapy or HSCT was considered as a separate event. Patients were followed up for development of IFI from the time of each admission to time of discharge or time of death. Outcomes of patients with IFI upon discharge were recorded. Clinical and mycological data during each admission were collected and analysed.

Eighty-three patients with mean age of 58.8±15.5 years were recruited. Acute myeloid leukemia (AML) was the most common diagnosis (45.8%). A total of 132 admissions were analysed from these 83 patients. Antifungal prophylaxes were prescribed in 94.7% of admissions with fluconazole being the most common agent used (88.6%). The incidence of proven and probable IFI was 7.6%. Candida tropicalis was the most common fungi isolated from these patients (22.7%), followed by Candida krusei (13.6%). The mortality rate due to IFI was 17.6%. Patients with AML and those with concomitant bacteraemia were associated with higher risk of IFI (odds ratio [OR] 3.69, 95% confidence interval [CI] 1.16-11.71, p=0.029 and OR 4.17, 95% CI 1.37-12.66, p=0.009, respectively), while the use of antifungal prophylaxis was associated with lower IFI risk (OR 0.17, 95% CI 0.03-0.83, p=0.045). After multivariate analysis, the use of antifungal prophylaxis remains significantly associated with lower risk of IFI (OR 0.54, 95% CI 0.01-0.62, p=0.019).

IFI remains one of serious complications of HM patients undergoing chemotherapy and HSCT, most commonly due to non-albicans Candida spp. Appropriate antifungal prophylaxis is therefore crucial in the prevention of breakthrough IFI.