title: [Invasive fungal infections in patients with blood disorders].
abstract: 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.
  
  
  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.
authors.affiliation: Servicios de Hematología y Microbiología, Hospital Universitario La Fe, Valencia.
authors.forename: F
authors.initials: F
authors.lastname: López
authors.forename: I
authors.initials: I
authors.lastname: Jarque
authors.forename: G
authors.initials: G
authors.lastname: Martín
authors.forename: G F
authors.initials: GF
authors.lastname: Sanz
authors.forename: J
authors.initials: J
authors.lastname: Palau
authors.forename: J
authors.initials: J
authors.lastname: Martínez
authors.forename: J
authors.initials: J
authors.lastname: de la Rubia
authors.forename: L
authors.initials: L
authors.lastname: Larrea
authors.forename: M
authors.initials: M
authors.lastname: Arnao
authors.forename: P
authors.initials: P
authors.lastname: Solves
authors.forename: J
authors.initials: J
authors.lastname: Cervera
authors.forename: M L
authors.initials: ML
authors.lastname: Martínez
authors.forename: J
authors.initials: J
authors.lastname: Pemán
authors.forename: M
authors.initials: M
authors.lastname: Gobernado
authors.forename: M A
authors.initials: MA
authors.lastname: Sanz
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007938:Leukemia / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications*; D009503:Neutropenia / Q000150:complications* / Q000175:diagnosis; D012189:Retrospective Studies; D012720:Severity of Illness Index
vernacular_title: Infecciones fúngicas invasoras en pacientes con hemopatías.