title: Invasive fungal infection among hematopoietic stem cell transplantation patients with mechanical ventilation in the intensive care unit.
abstract: BACKGROUND
  Invasive fungal infection (IFI) is associated with high morbidity and high mortality in hematopoietic stem cell transplantation (HSCT) patients. The purpose of this study was to assess the characteristics and outcomes of HSCT patients with IFIs who are undergoing MV at a single institution in Taiwan.
  
  
  METHODS
  We performed an observational retrospective analysis of IFIs in HSCT patients undergoing mechanical ventilation (MV) in an intensive care unit (ICU) from the year 2000 to 2009. The characteristics of these HSCT patients and risk factors related to IFIs were evaluated. The status of discharge, length of ICU stay, date of death and cause of death were also recorded.
  
  
  RESULTS
  There were 326 HSCT patients at the Linkou Chang-Gung Memorial Hospital (Taipei, Taiwan) during the study period. Sixty of these patients (18%) were transferred to the ICU and placed on mechanical ventilators. A total of 20 of these 60 patients (33%) had IFIs. Multivariate analysis indicated that independent risk factors for IFI were admission to an ICU more than 40 days after HSCT, graft versus host disease (GVHD), and high dose corticosteroid (p < 0.01 for all). The overall ICU mortality rate was 88% (53 of 60 patients), and was not significantly different for patients with IFIs (85%) and those without IFIs (90%, p = 0.676).
  
  
  CONCLUSIONS
  There was a high incidence of IFIs in HSCT patients requiring MV in the ICU in our study cohort. The independent risk factors for IFI are ICU admission more than 40 days after HSCT, GVHD, and use of high-dose corticosteroid.
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
authors.forename: Chen-Yiu
authors.initials: CY
authors.lastname: Hung
authors.forename: Kuo-Chin
authors.initials: KC
authors.lastname: Kao
authors.forename: Po-Nan
authors.initials: PN
authors.lastname: Wang
authors.forename: Han-Chung
authors.initials: HC
authors.lastname: Hu
authors.forename: Meng-Jer
authors.initials: MJ
authors.lastname: Hsieh
authors.forename: Jui-Ying
authors.initials: JY
authors.lastname: Fu
authors.forename: Chih-Hao
authors.initials: CH
authors.lastname: Chang
authors.forename: Li-Fu
authors.initials: LF
authors.lastname: Li
authors.forename: Chung-Chi
authors.initials: CC
authors.lastname: Huang
authors.forename: Ying-Huang
authors.initials: YH
authors.lastname: Tsai
authors.forename: Cheng-Ta
authors.initials: CT
authors.lastname: Yang
mesh_terms: D000328:Adult; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000401:mortality; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome