Introduction: Invasive aspergillosis (IA) is an important cause of morbidity and mortality in patients with haematologic malignancies (HM). The changes in the population at risk for IA due to intensified and new treatment strategies require a continuous re-evaluation of risk factors for IA. We conducted a retrospective case control study at a tertiary teaching hospital in order to identify risk factors for IA among patients with HM during the hospital construction period. Methods: In this study, we evaluated the risks among 41 case patients who developed proven, probable, or possible IA according to standardized definitions in HM patients between July 2000 and May 2005. Control patients with no signs and symptoms of IA were matched for the time and place. The clinical data analysed included demographic characteristics; Charlson comorbidity score at the time of diagnosis of IA, the type of haematologic neoplasm risk factors for IA present at or within 1 month before the diagnosis of infection and previous antifungal use within 3 months of diagnosis of infection. Risk factors associated with IA were identified in a multivariable Cox regression model. Results: In total, 41 IA cases (eight proven, ten probable, 23 possible), and 170 controls were analysed. Forty-three patients (20.4%) had AML, 27 (12.8%) had ALL, 85 (40.3%) had lymphoma, 33 (15.6%) had myeloma, 7 (3.3%) had myelodysplastic syndrome, and 18 (8.5%) had other disease. Anatomic sites of infection included lungs (n = 31), sinus or nose (n = 6), skin (n = 2), spine (n = 1), and skeletal muscle (n = 1). Variables that increased the risk for IA included duration of hospitalization (HR, 1.022; 95% CI, 1.002- 1.042; p, 0.031), AML (HR, 0.031; 95% CI, 0.001-0.762; p, 0.033), malnutrition (HR, 4.812; 95% CI, 1.309- 17.689; p, 0.018), and high iron level (HR, 1.001; 95% CI, 1.000-1.001; p, 0.017). Twenty patients died (48.8%) among IA and death was attributed to IA. Conclusion: Results of risk factor analysis indicated that important variables predictive of IA included longer duration of hospitalization, non-AML, malnutrition, and high iron level. These results contribute to the further characterization of patients groups at high risk of IA and may help to target costly prophylactic measures against IA.
Full conference title:
16th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 16th (2006)