Epidemiology and Outcomes of Invasive Fungal Infections in 398 Allogeneic Hematopoietic Stem Cell Transplant Recipients


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Weill Cornell Medical College, New York, NY


Background: With the advent of antifungal prophylaxis and early empirical antifungal therapy, the epidemiology of invasive fungal infections (IFIs) after allogeneic HSCT continues to evolve and uncommon pathogens may be emerging. Methods: We conducted a retrospective study of all EORTC-MSG proven and probable IFIs occurring in allogeneic HSCT recipients between January 2002-April 2011 and determined the incidence of IFI after transplant. We then reviewed patient demographics and clinical and microbiological characteristics of IFIs and assessed factors associated with survival after IFI using a multivariate Cox proportional hazards model. Results: Sixty-one proven or probable IFIs occurred in 53 allogeneic HSCT recipients. The cumulative incidence of IFI after transplant was 13.6% (53 of a total of 398 allogeneic HSCT recipients). During the study period, fluconazole was the primary antifungal agent used for prophylaxis. Patients with graft-versus-host disease on immunosuppressive therapies received voriconazole. The median time to development of IFI after transplant was 147 days (range 6-2130). Sixty-two percent of IFIs occurred after day 100 and 28% occurred after day 365. The most common IFIs were aspergillosis (n=23), candidemia (n =16), zygomycosis (n =3), and Pneumocystis jiroveci (n =3). The most common Candida species were C. parapsilosis (n =5), C. krusei (n =4), C. albicans (n =3), and C. glabrata (n =3). During the last study year, we observed three rare causes of IFI in patients receiving prophylaxis with either voriconazole or posaconazole: Geosmithia argillacea, Aspergillus calidoustus and Hormographiella aspergillata . The overall mortality rates at 30 and 90 days after IFI diagnosis were 32% and 49%, respectively. The presence of a viral infection other than cytomegalovirus (CMV) was independently associated with an increased risk of death (hazard ratio [HR] 10.0, P

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ID Week 2012
    • IDWeek 2012