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[Invasive fungal infections in patients with blood disorders]
1Servicios de Hematología y Microbiología, Hospital Universitario La Fe, Valencia.
Background:
Invasive fungal infections (IFI) are severe infectious complications frequently observed in patients with hematological disorders. The aims of this study were to analyse the characteristics of this particular type of infection in a large series of a single institution and to determine the factors associated with the outcome and therapeutic response.
Patients And Methods:
This study reviews the clinical and microbiological features of 155 IFI occurred among 144 patients with hematologic disorders throughout a period of 17 years in a single institution.
Results:
In 118 cases (82%) the diagnosis was acute leukemia. The main risk factors for developing IFI included a persistent and profound granulocytopenia, the use of broad-spectrum antibacterial agents, indwelling central venous catheters and the damage of normal host barriers following intensive cytotoxic chemotherapy. Candida (65 cases [44%]) and Aspergillus (38 cases [26%]) species were the most common fungal species isolated. An increasing number of IFI were caused by fungi previously considered as contaminants or harmless colonizers. The outcome of IFI was favourable in 78 cases (50%). The most important prognostic factors for the outcome of the IFI were the phase of cytotoxic chemotherapy (p = 0.005), the response of the underlying disease to the cytotoxic chemotherapy (p < 0.00001), and the recovery of neutropenia during the infection course (p < 0.00001). An earlier use of empirical antifungal therapy was also associated with a better outcome.
Conclusions:
In spite of earlier treatment and regardless the development of new antifungal agents, the prognosis of IFI in patients with hematological malignancies remains poor. The use of hematopoietic growth factors, through their impact in the duration and severity of neutropenia, may prove valuable the management of IFI in this setting.
Insights
Invasive fungal infections (IFI) in patients with hematologic disorders have a poor prognosis despite advances in treatment. Early antifungal therapy and managing neutropenia are key to improving outcomes for these severe infections.
Area of Science:
- Hematology
- Infectious Diseases
- Mycology
Context:
- Invasive fungal infections (IFI) are significant complications in patients with hematological disorders.
- This study analyzes 155 IFIs in 144 patients over 17 years at a single institution.
Purpose:
- To characterize IFIs in hematologic malignancy patients.
- To identify factors influencing IFI outcomes and therapeutic response.
Summary:
- Acute leukemia was the most common diagnosis (82%).
- Key risk factors included profound granulocytopenia, broad-spectrum antibiotics, central venous catheters, and chemotherapy-induced barrier damage.
- Candida (44%) and Aspergillus (26%) were most common; previously overlooked fungi are emerging pathogens.
- Favorable outcomes occurred in 50% of cases.
- Prognostic factors included chemotherapy phase, underlying disease response, neutropenia recovery, and early empirical antifungal therapy.
Impact:
- IFI prognosis in hematologic malignancies remains poor despite new treatments.
- Hematopoietic growth factors may improve IFI management by reducing neutropenia duration and severity.