LETHAL INFECTIONS IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES

The hospital files of 410 patients with hematological malignancy treat ed at our clinic between 1977 and 1990 were reviewed to determine the importance of infections as a cause of death. The total number of infe ctions was 203 (49.5%). A microbiologically documented infection was d etected in 27.3%, a clinically documented infection in 9.5% and a poss ible infection in 12.7% of the patients. Gram-positive bacteria were r esponsible for 25.9%, gram-negative bacteria for 31.3%, anaerobic bact eria for 2.7%, viruses for 4.5% and fungi for 25.9% of the microbiolog ically documented infections. Of 29 systemic fungal infections only 2 were diagnosed before the patients died. The remaining diagnoses reste d on autopsy findings. Empiric antifungal therapy was introduced in 19 83; still, 74.2% of systemic fungal infections in 1977-1990 were detec ted after 1982. Patients with a verified infection had statistically s ignificantly higher CRP concentrations than patients who died of other causes (152 mg/l vs. 117.5 mg/l, p = 0.018). We conclude that infecti on is a significant cause of death in patients with these diseases. Th e number of systemic fungal infections is increasing, despite the wide spread use of antifungal medication and thus better diagnostic methods and more effective treatment are needed.