Lethal infections in patients with hematological malignancies.
The hospital files of 410 patients with hematological malignancy treated at our clinic between 1977 and 1990 were reviewed to determine the importance of infections as a cause of death. The total number of infections was 203 (49.5%). A microbiologically documented infection was detected in 27.3%, a clinically documented infection in 9.5% and a possible infection in 12.7% of the patients. Gram-positive bacteria were responsible for 25.9%, gram-negative bacteria for 31.3%, anaerobic bacteria for 2.7%, viruses for 4.5% and fungi for 25.9% of the microbiologically documented infections. Of 29 systemic fungal infections only 2 were diagnosed before the patients died. The remaining diagnoses rested on autopsy findings. Empiric antifungal therapy was introduced in 1983; still, 74.2% of systemic fungal infections in 1977-1990 were detected after 1982. Patients with a verified infection had statistically significantly higher CRP concentrations than patients who died of other causes (152 mg/l vs. 117.5 mg/l, p = 0.018). We conclude that infection is a significant cause of death in patients with these diseases. The number of systemic fungal infections is increasing, despite the widespread use of antifungal medication and thus better diagnostic methods and more effective treatment are needed.
Department of Medicine, Turku University Central Hospital, Finland.
J
J
Salonen
J
J
Nikoskelainen
D001228:Aspergillosis / Q000209:etiology / Q000401:mortality; D001424:Bacterial Infections / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D002177:Candidiasis / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D003586:Cytomegalovirus Infections / Q000209:etiology / Q000401:mortality; D006090:Gram-Negative Bacteria; D006094:Gram-Positive Bacteria; D006561:Herpes Simplex / Q000209:etiology / Q000401:mortality; D006801:Humans; D007239:Infections / Q000209:etiology / Q000382:microbiology / Q000401:mortality*; D007938:Leukemia / Q000150:complications*; D009101:Multiple Myeloma / Q000150:complications; D009181:Mycoses / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D014777:Virus Diseases / Q000209:etiology / Q000401:mortality