Fungaemia in haematological malignancies: SEIFEM-2015 survey.
acute leukaemias
candidemia
fungaemia
Journal
European journal of clinical investigation
ISSN: 1365-2362
Titre abrégé: Eur J Clin Invest
Pays: England
ID NLM: 0245331
Informations de publication
Date de publication:
May 2019
May 2019
Historique:
received:
28
08
2018
revised:
29
01
2019
accepted:
04
02
2019
pubmed:
9
2
2019
medline:
18
12
2019
entrez:
9
2
2019
Statut:
ppublish
Résumé
Fungal infections are still a relevant challenge for clinicians involved in the cure of patients with cancer. We retrospectively reviewed charts of hospitalized patients with haematological malignancies (HMs), in which a documented fungaemia was diagnosed between January 2011 and December 2015 at 28 adult and 6 paediatric Italian Hematology Departments. During the study period, we recorded 215 fungal bloodstream infections (BSI). Microbiological analyses documented that BSI was due to moulds in 17 patients (8%) and yeasts in 198 patients (92%), being Candida spp identified in 174 patients (81%). Mortality rates were 70% and 39% for mould and yeast infections, respectively. Infection was the main cause of death in 53% of the mould and 18% of the yeast groups. At the multivariate analysis, ECOG ≥ 2 and septic shock were significantly associated with increased mortality, and removal of central venous catheter (CVC) survival was found to be protective. When considering patients with candidemia only, ECOG ≥ 2 and removal of CVC were statistically associated with overall mortality. Although candidemia represents a group of BSI with a good prognosis, its risk factors largely overlap with those identified for all fungaemias, even though the candidemia-related mortality is lower when compared to other fungal BSI. Management of fungal BSI is still a complex issue, in which both patients and disease characteristics should be focused to address a personalized approach.
Sections du résumé
BACKGROUND
BACKGROUND
Fungal infections are still a relevant challenge for clinicians involved in the cure of patients with cancer. We retrospectively reviewed charts of hospitalized patients with haematological malignancies (HMs), in which a documented fungaemia was diagnosed between January 2011 and December 2015 at 28 adult and 6 paediatric Italian Hematology Departments.
METHODS
METHODS
During the study period, we recorded 215 fungal bloodstream infections (BSI). Microbiological analyses documented that BSI was due to moulds in 17 patients (8%) and yeasts in 198 patients (92%), being Candida spp identified in 174 patients (81%).
RESULTS
RESULTS
Mortality rates were 70% and 39% for mould and yeast infections, respectively. Infection was the main cause of death in 53% of the mould and 18% of the yeast groups. At the multivariate analysis, ECOG ≥ 2 and septic shock were significantly associated with increased mortality, and removal of central venous catheter (CVC) survival was found to be protective. When considering patients with candidemia only, ECOG ≥ 2 and removal of CVC were statistically associated with overall mortality.
CONCLUSIONS
CONCLUSIONS
Although candidemia represents a group of BSI with a good prognosis, its risk factors largely overlap with those identified for all fungaemias, even though the candidemia-related mortality is lower when compared to other fungal BSI. Management of fungal BSI is still a complex issue, in which both patients and disease characteristics should be focused to address a personalized approach.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13083Investigateurs
Giulia Dragonetti
(G)
Stelvio Ballanti
(S)
Mario Delia
(M)
Gianpaolo Nadali
(G)
Sciumè M
(S)
Castagnola C
(C)
Ferrari A
(F)
Mancini V
(M)
Decembrino N
(D)
Spolzino A
(S)
Iovino L
(I)
Martino B
(M)
Vacca A
(V)
Calore E
(C)
Fanci R
(F)
Lessi F
(L)
Vallero S
(V)
Zama D
(Z)
Cesaro S
(C)
De Paolis Mr
(P)
Facchini L
(F)
Muggeo P
(M)
Offidani M
(O)
Perruccio K
(P)
Russo D
(R)
Informations de copyright
© 2019 Stichting European Society for Clinical Investigation Journal Foundation.