Objectives: To evaluate the incidence and the outcome of fungal infections (FI) in patients (pts) affected by hematological malignancies (HM). Methods: A retrospective study, conducted over 1999-2003, in pts with HM, admitted in 18 Italian haematology divisions in tertiary cares or university hospitals, which developed proven or probable FI. Results: The population included 11,802 pts: 3,012 with AML (25.5%), 1,173 with ALL (9.9%), 596 with CML (5%), 1,104 with CLL (9.4%), 1,616 with MM (13.7%), 3,457 with NHL (29.3%), 844 with HL (7.2%). Pts who underwent autologous or allogenic HSCT were included in a specific different analysis. A proven or probable FI occurred in 538 pts, with an incidence of 4.6%; in particular we registered 346 episodes sustained by moulds (incidence 2.9%) and 192 by yeasts (1.6%). The incidence rate depends upon underlying HM (12.3% in AML, 6.5% in LLA, 2.5% in CML, 0.5% in CLL, 0.5% in MM, 1.6% in NHL, 0.7% in HL). Among moulds, the detected etiological agents were Aspergillus spp. (310 episodes, incidence 2.6%), Mucorales spp. (14 episodes, 0.1%), Fusarium spp. (15 episodes, 0.1%), and other rare fungi (7 episodes, 0.1%). Among yeasts we registered septicemia sustained by Candida spp. (175 pts, incidence 1.5%). Other yeast infections were caused by Cryptococcus spp. (8 pts, incidence 0.1%), Tricosporon spp. (7 pts, 0.1%) and other rare agents (2 pts). The overall mortality rate was 1.8%. Among 538 pts with FI, case fatality rate (CFR) was 39%, with differences between aspergillosis (42%), zygomycosis (64%), fusariosis (53%) and candidemia (33%). There was not variation in mortality rate during the study period; comparing these pts with those observed in our previous epidemiological studies during the period 1987- 1988 we observed a significant reduction of deaths due to aspergillosis (RR 1.90; 95%CI 1.17-3.09), but no differences in mortality rate due to Candida spp. Conclusion: Our study confirms the general trends already described: infections due to moulds continue to be more frequent than those caused by yeast. Among all fungi, Aspergillus spp. remains the main etiologic agent, followed by Candida spp. Other agents (Mucorales spp., Fusarium spp., Trichosporon spp.) remain rare. AML represents the most frequently involved category. The mortality rate due to aspergillosis is actually about 40%, with a remarkable decrease when compared to past years; as for candidemia, we observed a reduction in the incidence, but not in the mortality rate.
Full conference title:
16th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 16th (2006)