Overall survival and fungal infection-related mortality in patients with invasive fungal infection and neutropenia after myelosuppressive chemotherapy in a tertiary care centre from 1995 to 2006

Abstract

ObjectivesInvasive fungal infections (IFIs) contribute significantly to mortality and morbidity in patients receiving myelosuppressive chemotherapy for haematological malignancies. The present study investigates the overall survival (OS), infection-related mortality and changes in treatment of IFIs in our department from 1995 until 2006.MethodsOutcomes of all chemotherapy courses were retrospectively evaluated using a standard questionnaire. Modified EORTC/MSG criteria for IFIs were applied: a positive PCR result for Aspergillus spp. in bronchoalveolar lavage was also defined as probable IFI.ResultsIn total, 1693 chemotherapy courses in 592 patients were evaluated. Sixty-three percent of chemotherapy courses were given to treat acute myeloid leukaemia, with the rest for acute lymphoblastic leukaemia or aggressive lymphoma. IFIs were observed in 139/592 patients [23.5%, 95% confidence interval (CI) 20%–27%] and in 149/1693 courses (8.8%, 95% CI 8%–10%). IFI-related mortality was 56.9% in 1995–2001 and 28.6% in 2002–06, P < 0.001. Accordingly, median OS in patients with IFI increased: 54 days (95% CI 26–82 days) in 1995–2001 versus 229 days (95% CI 35–423 days) in 2002–06, P = 0.001. By multivariate analysis, factors predictive for better OS were controlled disease after chemotherapy [hazard ratio (HR) 0.228, P < 0.001], possible IFI (in contrast to proven/probable IFI, HR 0.537, P = 0.005), age <60 years (HR 0.583, P = 0.008), time period 2002–06 (HR 0.612, P = 0.021) and use of novel antifungals (HR 0.589, P = 0.033).ConclusionsCompared with 1995–2001, IFI-related mortality decreased and OS in patients with IFI increased significantly in recent years. Improved OS was associated with controlled haematological disease, certainty of IFI diagnosis (possible), younger age, time period 2002–06 and the use of novel antifungals.

Community acquired pneumonia-current scenario among immunocompromised patients in a tertiary care hospital

“…Studies conducted by Mulanovich VE et al, [17] and Pagano L et al, [18], on fungal pneumonia in hematological malignancies, showed that these malignancies pose an important threat for developing fungal pneumonia. Study conducted by Corinna Hahn et al, [19] in 2006, showed that the prevalence of fungal pneumonia in hematological patients vary between 2-40%, depending on their ongoing treatment protocol. Study conducted by Spomenka Ljubic et al, [14] showed that about 20-25 % of pneumonia in diabetes patients are polymicrobial in nature and fungal pneumonias are common in these patients than with control groups.…”

Breakthrough Hormographiella aspergillata Infections Arising in Neutropenic Patients Treated Empirically with Caspofungin

“…are the fungi most frequently involved (22). Despite major advances in diagnostic procedures and antifungal therapy in the last decade, the prognosis of IFI in the setting of hematological malignancies remains poor, with close to 50% of patients failing frontline treatment and a mortality rate in the range of 30% (12). The advent of new diagnostic tools, including serum enzyme-linked immunosorbent assay (ELISA) for GMA (18), qPCR of fungal DNA (20,27), and computed tomography of the lungs (11), has allowed early detection of IFI and prompt treatment.…”

Concentração de cálcio no dialisato e hipercalcemia na DRC

“…12 Therefore, patients with APL on ATRA therapy may need antifungal therapy. [13][14][15] Since its discovery, in 1955, amphotericin B (AB) 16,17 remains as the antimicrobial of choice for this practice, as well as for the treatment of confirmed systemic fungal infections. 16,18 However, AB is associated with chronic and acute adverse effects, especially nephrotoxicity, which may cause renal damage and electrolytic disorder (hypokalemia and hypomagnesemia).…”