Abstract
Invasive fungal infections (IFIs) are a leading cause of morbidity and attributable mortality in oncohematologic patients. Timely diagnosis is essential but challenging. Herein we retrospectively describe 221 cases of antifungal treatments (AFT) administered in a monocentric real-life cohort of hematological malignancies. Between January 2010 and July 2017, 196 oncohematologic patients were treated with AFT at our Hematology Department. Diagnosis of IFIs was carried out according to EORTC/MSG-2008 guidelines.The most represented disease was acute myeloid leukemia (104 patients). Median age was 61 years; at fever onset 177 (80%) patients had a neutrophil count<0.5x109/L. Twenty-nine (13%) patients were receiving antifungal prophylaxis (26 posaconazole, 2 fluconazole, 1 itraconazole). The incidence of AFT was 13%. Serum galactomannan antigen (GM) was positive in 20% of the tested cases, while 85% of the patients had a CT scan suggestive for IFI. Twenty-one percent of these cases had a GM positive. Sixty-five out of 196 patients (33%) showed positive culture results, in particular Candida spp. were identified in 45 isolates, while Aspergillus spp. in 16 cases. Fourteen patients presented multiple positivity. Twenty-two (10%) cases were classified as proven IFIs, 61 (28%) as probable and 81 (37%) as possible, but 57 (26%) cases could not be classified. Fifty-nine percent of the patients received single agent AFT, 37% sequential AFT, 8% a combination regimen. Liposomal-amphotericin-B was the most used AFT. IFIs attributable mortality was 20%. This epidemiologic survey underlined a persistent significant use of AFT and a high mortality rate of IFIs. We suggest that further powerful diagnostic approaches should be investigated to improve the diagnostic accuracy and potential therapeutic implication.
Highlights
A study based on autoptical findings confirmed that acute myelogenous leukaemia (AML) and myelodysplastic syndromes (MDS) are the hematologic malignancies more frequently associated with IFIs
All the patients had a diagnosis of hematological malignancy and persistent fever after 72 hours of antibacterial therapy or fever relapsing after 48 hours of defervescence
In the present retrospective study, we report the results of a single center real-life experience in a large series of 1719 hospitalization and 221 antifungal treatments (AFT) in 196 patients with oncohematological diseases
Summary
Invasive fungal infections (IFIs) are a leading cause of morbidity and attributable mortality in patients with hematologic diseases and in those receiving intensive chemotherapy or undergoing hematopoietic stem cell transplant (HSCT) [1,2,3]. The most frequent invasive fungal pathogens are Candida and Aspergillus species (spp) [1,2,3]. A study based on autoptical findings confirmed that acute myelogenous leukaemia (AML) and myelodysplastic syndromes (MDS) are the hematologic malignancies more frequently associated with IFIs. high rates of proven invasive fungal disease has been recently noted in patients with non-Hodgkin lymphomas (NHL) in the era of target drugs [9,10]
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