Invasive fungal infection among hematopoietic stem cell transplantation patients with mechanical ventilation in the intensive care unit

Chen-Yiu Hung,Jui-Ying Fu,Kuo-Chin Kao,Cheng-Ta Yang,Po-Nan Wang,Meng-Jer Hsieh,Chih-Hao Chang,Han-Chung Hu,Li-Fu Li,Ying-Huang Tsai,Chung-Chi Huang

doi:10.1186/1471-2334-12-44

Abstract

BackgroundInvasive fungal infection (IFI) is associated with high morbidity and high mortality in hematopoietic stem cell transplantation (HSCT) patientsThe 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.MethodsWe 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.ResultsThere 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).ConclusionThere 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.

Highlights

Invasive fungal infection (IFI) is associated with high morbidity and high mortality in hematopoietic stem cell transplantation (HSCT) patientsThe purpose of this study was to assess the characteristics and outcomes of Hematopoietic stem cell transplantation (HSCT) patients with IFIs who are undergoing mechanical ventilation (MV) at a single institution in Taiwan
The results indicate that intensive care unit (ICU) admission more than 40 days after HSCT, diagnosis of graft versus host disease (GVHD), and use of high dose corticosteroid were significantly and independently associated with IFIs
The major findings of this study were that HSCT patients undergoing MV in the ICU had a high incidence of IFI (33%) and high ICU mortality (88%)

Summary

Introduction

Invasive fungal infection (IFI) is associated with high morbidity and high mortality in hematopoietic stem cell transplantation (HSCT) patientsThe 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. Despite improvements in HSCT, its widespread adoption has been limited due to the high rate of severe complications associated with the toxicity of the conditioning regimen, immunosuppression, and graft-versus-host disease (GVHD) [1]. These complications are commonly related to the underlying illness and often require admission to an intensive care unit (ICU) [2,3]. Despite advances in HSCT procedures, improved prophylactic antifungal agents, and better ICU care, mortality and morbidity remain major concerns for HSCT patients with IFIs [7]

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