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: 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: 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: 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.

Fungaemia in haematological malignancies: SEIFEM-2015 survey / Criscuolo, M.; Marchesi, F.; Candoni, A.; Cattaneo, C.; Nosari, A.; Veggia, B.; Verga, L.; Fracchiolla, N.; Vianelli, N.; Del Principe, M. I.; Picardi, M.; Tumbarello, M.; Aversa, F.; Busca, A.; Pagano, L.; Dragonetti, G.; Ballanti, S.; Delia, M.; Nadali, G.; Sciume, M.; Castagnola, C.; Ferrari, A.; Mancini, V.; Decembrino, N.; Spolzino, A.; Iovino, L.; Martino, B.; Vacca, A.; Calore, E.; Fanci, R.; Lessi, F.; Vallero, S.; Zama, D.; Cesaro, S.; De Paolis, M. R.; Facchini, L.; Muggeo, P.; Offidani, M.; Perruccio, K.; Russo, D.. - In: EUROPEAN JOURNAL OF CLINICAL INVESTIGATION. - ISSN 0014-2972. - 49:5(2019), pp. 13083-13090. [10.1111/eci.13083]

Fungaemia in haematological malignancies: SEIFEM-2015 survey

Candoni A.;
2019-01-01

Abstract

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: 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: 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: 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.
49
5
13083
13090
Fungaemia in haematological malignancies: SEIFEM-2015 survey / Criscuolo, M.; Marchesi, F.; Candoni, A.; Cattaneo, C.; Nosari, A.; Veggia, B.; Verga, L.; Fracchiolla, N.; Vianelli, N.; Del Principe, M. I.; Picardi, M.; Tumbarello, M.; Aversa, F.; Busca, A.; Pagano, L.; Dragonetti, G.; Ballanti, S.; Delia, M.; Nadali, G.; Sciume, M.; Castagnola, C.; Ferrari, A.; Mancini, V.; Decembrino, N.; Spolzino, A.; Iovino, L.; Martino, B.; Vacca, A.; Calore, E.; Fanci, R.; Lessi, F.; Vallero, S.; Zama, D.; Cesaro, S.; De Paolis, M. R.; Facchini, L.; Muggeo, P.; Offidani, M.; Perruccio, K.; Russo, D.. - In: EUROPEAN JOURNAL OF CLINICAL INVESTIGATION. - ISSN 0014-2972. - 49:5(2019), pp. 13083-13090. [10.1111/eci.13083]
Criscuolo, M.; Marchesi, F.; Candoni, A.; Cattaneo, C.; Nosari, A.; Veggia, B.; Verga, L.; Fracchiolla, N.; Vianelli, N.; Del Principe, M. I.; Picardi, M.; Tumbarello, M.; Aversa, F.; Busca, A.; Pagano, L.; Dragonetti, G.; Ballanti, S.; Delia, M.; Nadali, G.; Sciume, M.; Castagnola, C.; Ferrari, A.; Mancini, V.; Decembrino, N.; Spolzino, A.; Iovino, L.; Martino, B.; Vacca, A.; Calore, E.; Fanci, R.; Lessi, F.; Vallero, S.; Zama, D.; Cesaro, S.; De Paolis, M. R.; Facchini, L.; Muggeo, P.; Offidani, M.; Perruccio, K.; Russo, D.
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