RISK-FACTORS FOR FUNGAL INFECTION IN PATIENTS WITH MALIGNANT HEMATOLOGIC DISORDERS - IMPLICATIONS FOR EMPIRICAL THERAPY AND PROPHYLAXIS

To determine which patients are at high risk for disseminated fungal i nfection and should be given systemic prophylaxis, we studied the char ts of 341 patients with malignant hematologic disorders who were admit ted to our institution during 10 consecutive years. These patients rep resented 636 admissions; during these admissions, 60 invasive fungal i nfections occurred, with deaths in 44 cases. All patients who died of these infections either had persisting granulocytopenia and a poor pro gnosis for the underlying disease or suffered from chronic graft-vs.-h ost disease. Two of 58 patients who had no or low-level candidal colon ization developed disseminated candidal infection whereas eight of 23 with high-level colonization developed this infection (P < .001). Nine of the 10 patients with candidal infection had microbiologically prov en bacteremia within the week preceding the candidal infection. After bone marrow transplantation, 8 of 10 patients with chronic graft-vs.-h ost disease vs. 2 of 36 without this disease (P < .001) developed fata l infection with Aspergillus species. The results of our study reveal that patients with high-level candidal colonization who were treated f or microbiologically proven bacteremia and patients with chronic graft -vs.-host disease might benefit from systemic antifungal prophylaxis.