The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study
Pagano, L.; Caira, M.; Candoni, A.; Offidani, M.; Fianchi, L.; Martino, B.; Pastore, D.; Picardi, M.; Bonini, A.; Chierichini, A.; Fanci, R.; Caramatti, C.; Invernizzi, R.; Mattei, D.; Mitra, M.Enza.; Melillo, L.; Aversa, F.; Van Lint, M.Teresa.; Falcucci, P.; Valentini, C.Giovanna.; Girmenia, C.; Nosari, A.
Haematologica 91(8): 1068-1075
2006
ISSN/ISBN: 0390-6078 PMID: 16885047 Document Number: 604248
Objective: To evaluate the incidence and outcome of invasive fungal infections (IFI) in patients with haematologic malignancies. Methods: This was a retrospective cohort study of patients admitted between 1999 and 2003 to 18 haematology wards in Italy. Each participating centre provided information on all patients with newly diagnosed haematologic malignancies admitted during the survey period and on all episodes of IFI experienced by these patients. Results: A total of 11 802 patients with haematologic malignancies were identified: acute leukaemia (myeloid, n=3012; lymphoid, n=1173), chronic leukaemia (myeloid, n=596; lymphoid, n=1104), lymphoma (Hodgkin's, n=844; non-Hodgkin's, n=3457), or multiple myeloma (n=1616). There were 538 proven or probable IFI cases (4.6%); 373 (69%) occurred in patients with acute myeloid leukaemia. Over half (346/538) were caused by moulds (2.9%), in most cases Aspergillus spp. (310/346). There were 192 cases of yeast infections, including 175 cases of candidaemia. Overall and IFI-attributable mortality rates were 2% (209/11 802) and 39% (209/538), respectively. The highest IFI-attributable mortality rates were associated with zygomycosis (64%), followed by fusariosis (53%), aspergillosis (42%), and candidaemia (33%). Conclusions: Patients with haematologic malignancies are currently at higher risk for IFI caused by moulds than by yeasts, and the incidence of IFI is highest among patients with acute myeloid leukaemia. Aspergillus spp. are still the most common pathogens, followed by Candida spp. The attributable mortality rate for aspergillosis has dropped from 60-70% to ~40%. Candidaemia-related mortality remains within the 30-40% range reported in literature, although the incidence has decreased.