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Risk factors for fungal infection in patients with malignant hematologic disorders: implications for empirical
H F Guiot1, W E Fibbe, J W van 't Wout
1Department of Infectious Diseases, University Hospital, Leiden, The Netherlands.
Abstract:
To determine which patients are at high risk for disseminated fungal infection and should be given systemic prophylaxis, we studied the charts of 341 patients with malignant hematologic disorders who were admitted to our institution during 10 consecutive years. These patients represented 636 admissions; during these admissions, 60 invasive fungal infections occurred, with deaths in 44 cases. All patients who died of these infections either had persisting granulocytopenia and a poor prognosis for the underlying disease or suffered from chronic graft-vs.-host disease. Two of 58 patients who had no or low-level candidal colonization developed this infection (P < .001). Nine of the 10 patients with candidal infection had microbiologically proven bacteremia within the week preceding the candidal infection. After bone marrow transplantation, 8 of 10 patients with chronic graft-vs.-host disease vs. 2 of 36 without this disease (P < .001) developed fatal infection with Aspergillus species. The results of our study reveal that patients with high-level candidal colonization who were treated for microbiologically proven bacteremia and patients with chronic graft-vs.-host disease might benefit from systemic antifungal prophylaxis.
Insights
Patients with hematologic disorders and high-risk factors like persistent granulocytopenia or chronic graft-versus-host disease may benefit from antifungal prophylaxis to prevent invasive fungal infections.
Area of Science:
- Infectious Diseases
- Hematology
- Oncology
Background:
- Invasive fungal infections pose a significant threat to patients with malignant hematologic disorders.
- Identifying patients at high risk is crucial for implementing effective preventive strategies.
Purpose of the Study:
- To identify risk factors for disseminated fungal infections in patients with malignant hematologic disorders.
- To determine eligibility for systemic antifungal prophylaxis.
Main Methods:
- Retrospective chart review of 341 patients with malignant hematologic disorders over 10 years.
- Analysis of 636 admissions, focusing on invasive fungal infections and outcomes.
- Correlation of infection development with factors like granulocytopenia, graft-versus-host disease, candidal colonization, and bacteremia.
Main Results:
- 60 invasive fungal infections occurred in 636 admissions, with 44 deaths.
- High-risk factors included persisting granulocytopenia, poor prognosis, and chronic graft-versus-host disease.
- High-level candidal colonization (P < .001) and preceding bacteremia were associated with candidal infections.
- Fatal Aspergillus infections were more common in patients with chronic graft-versus-host disease post-bone marrow transplantation (P < .001).
Conclusions:
- Patients with high-level candidal colonization and treated bacteremia are at increased risk.
- Patients with chronic graft-versus-host disease, especially post-transplant, face a high risk of fatal fungal infections.
- Systemic antifungal prophylaxis may benefit these identified high-risk patient groups.