Incidence, epidemiology and prognosis of invasive fungal disease in a prospective cohort of haematological patients

Ref ID: 19184

Author:

A. Martí­n-Peña, M. Aguilar-Guisado, M. Ruí­z Pérez de Pipaón, M.V. Gil-Navarro, I. Montero-Cuadrado, J. González-Campos, R. Parody, F. Márquez-Malaver, I. Espigado, J.M. Cisneros

Author address:

Spanish Network for the Research in Infectious Diseases (REIPI)

Full conference title:

23rd European Congress of Clinical Microbiology and
Infectious Diseases

Date: 27 April 2014

Abstract:

The incidence of invasive fungal disease (IFD) is increasing among hematological patients and its etiology is changing due mainly to prophylaxis policies and changes in the host, while mortality remains high although may be decreasing. The epidemiology and outcome of IFD may differ in highest risk patients as acute myeloblastic leukemia (AML) and allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients.
Objective: To determine the incidence, epidemiology and outcome of IFD in overall hematological patients and in high risk patients.
Methods: Observational and prospective cohort study of consecutive probable or proven IFD episodes in hematological inpatients from July-11 to November-12. Primary antifungal prophylaxis was indicated in AML patients receiving chemotherapy of induction to remission (ICh) or rescue chemotherapy (RCh) and in allo-HSCT recipients. IFD attributable mortality was considered as death of patient receiving antifungal therapy for IFD without other known cause. Descriptive analysis of incidence, etiology, crude 30-day and IFD attributable mortality in the overall group and in the high risk group was performed.
Results: Forty-four probable or proven IFD in 421 patients (24.5% of them HSCT recipients) were diagnosed. The overall IFD incidence density was 2.52/1000 bed-days. The IFD prevalence in patients with AML was 24.6% (18.5% in patients receiving RCh, 16.7% in chemorresistant AML, 15.5% in patients receiving ICh); and in allo-HSCT recipients was 13.6%. The etiology of IFD was invasive aspergillosis (IA) in 29 episodes (65.9%) and invasive candidiasis (IC) in 13 (29.6%). There were one fusariosis and one mucormycosis episode (4.5% respectively). In allo-HSCT recipients, all IFD were probable IA. Overall 30 day crude mortality was 40.9%; in patients with AML was 47.1% and 0% in allo-HSCT recipients. Overall IFD attributable mortality was 34.1%, 35.3% in patients with AML and 16.6% in allo-HSCT recipients. AI and IC attributable mortality were 37.9% and 15.4% respectively. Both patients with emerging IFD died.
Conclusions: IFD incidence is high in high risk hematological patients risk in spite of antifungal prophylaxis. The highest IFD incidence is in patients with AML receiving rescue chemotherapy. The most frequent etiology (and the only one in allo-HSCT recipients) is Aspergillus spp., being also the IFD with worse outcome. Crude mortality of IFD is decreasing but remains high, especially in AML and in invasive mould diseses.

Abstract Number: P1047

Conference Year: 2013

Link to conference website: http://registration.akm.ch/einsicht.php?XNABSTRACT_ID=164401&XNSPRACHE_ID=2&XNKONGRESS_ID=180&XNMASK

New link: NULL

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