Significant alterations in the epidemiology and treatment outcome of invasive fungal infections in patients with hematological malignancies.
Invasive fungal infections (IFI) remain a leading cause of morbidity and mortality in immunocompromised patients. This retrospective single-center study analyzed incidence, treatment and outcome of invasive fungal infections in 1,095 patients with hematological malignancies receiving either cytoreductive chemotherapy or autologous or allogeneic hematopoietic stem cell transplantation at our institution between 1995 and 2004. IFI occurred in 167/1,095 (15%) patients with a significant increase over time (12.7% between 1995 and 2000 vs. 18.1% in the later IFI cohort, P = 0.0134). Fifty-four (32%) patients had proven, 70 (42%) patients had probable, and 43 (26%) patients suffered from possible IFI according to EORTC/MSG criteria. In 108/124 (87%) cases with proven or probable IFI, moulds were the causative pathogens. Both, Aspergillus fumigatus (n = 46) and Aspergillus terreus (n = 41) were predominant. Yeast infections (Candida spp.) were documented in 16/124 (10%) cases with proven or probable IFI. Median overall survival of the entire IFI cohort was 7 (3-17) months. Overall survival was significantly better in patients with probable or possible IFI (37 and 38%, respectively) compared with patients with proven IFI (28%, P = 0.019). In 35% of patients, IFI was the principal cause of death with a significant decrease over time (44% in time cohort 1995-2000 vs. 28% in the later IFI cohort, P = 0.018) accompanied by an increased use of novel antifungals. By multivariate analysis, only proven IFI was significantly predictive for death (HR 1.7, P = 0.018). A significant decrease in fungus-related deaths was observed despite a significant increase of IFI over time, probably due to improved diagnostic and therapeutic approaches.
Auberger
Jutta
J
Department of Internal Medicine, Division of Hematology and Oncology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria. jutta.auberger@i-med.ac.at.
Lass-Flörl
Cornelia
C
Section Hygiene, Institute for Hygiene and Social Medicine, Innsbruck Medical University, Innsbruck, Austria.
Ulmer
Hanno
H
Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria.
Nogler-Semenitz
Elisabeth
E
Hospital Pharmacy of Innsbruck University Hospital, Innsbruck Medical University, Innsbruck, Austria.
Clausen
Johannes
J
Department of Internal Medicine, Division of Hematology and Oncology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
Gunsilius
Eberhard
E
Department of Internal Medicine, Division of Hematology and Oncology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
Einsele
Hermann
H
Department of Internal Medicine II, University of Würzburg, Würzburg, Germany.
Gastl
Günther
G
Department of Internal Medicine, Division of Hematology and Oncology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
Nachbaur
David
D
Department of Internal Medicine, Division of Hematology and Oncology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000382:microbiology / Q000401:mortality* / Q000628:therapy; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D015996:Survival Rate; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
D000935:Antifungal Agents