INVASIVE FUNGAL-INFECTIONS IN HEMATOLOGIC PATIENTS

BACKGROUND: invasive fungal infections (IFI) are severe infectious com plications frequently observed in patients with hematological disorder s. The aims of this study were to analyse the characteristics of this particular type of infection in a large series of a single institution and to determine the factors associated with the outcome and therapeu tic response. PATIENTS AND METHODS: This Study reviews the clinical an d microbiological features of 155 IFI occurred among 144 patients with hematologic disorders throughout a period of 17 years in a single ins titution. RESULTS: In 118 cases (82%) the diagnosis was acute leukemia . The main risk factors for developing IFI included a persistent and p rofound granulocytopenia, the use of broad-spectrum antibacterial agen ts, indwelling central venous catheters and the damage of normal host barriers following intensive cytotoxic chemotherapy. Candida (65 cases [44%]) and Aspergillus (38 cases [26%]) species were the most common fungal species isolated. An increasing number of IFI were caused by fu ngi previously considered as contaminants or harmless colonisers. The outcome of IFI was favourable in 78 cases (50%). The most important pr ognostic factors for the outcome of the IFI were the phase of cytotoxi c chemotherapy (p = 0.005), the response of the underlying disease to the cytotoxic chemotherapy (p < 0.00001), and the recovery of neutrope nia during the infection course (p < 0.00001). An earlier use of empir ical antifungal therapy was also associated with a better outcome. CON CLUSIONS: In spite of earlier treatment and regardless the development of new antifungal agents, the prognosis of IFI in patients with hemat ological malignancies remains poor. The use of hematopoietic growth fa ctors, through their impact in the duration and severity of neutropeni a, may prove valuable the management of IFI in this setting.