Fungaemia in haematological malignancies: SEIFEM-2015 survey
Fungaemia in haematological malignancies: SEIFEM-2015 survey
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DOI：
10.1111/eci.13083
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发表时间：
2019-05-01
影响因子：
5.5
通讯作者：
Russo, D.
中科院分区：
文献类型：
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作者：
Criscuolo, Marianna;Marchesi, Francesco;Russo, D.
背景：真菌感染仍然是参与癌症患者治疗的临床医生面临的一个相关挑战。我们回顾性分析了血液系统恶性肿瘤（HMs）住院患者的病历，其中2011年1月至2015年12月期间在28个成人和6个儿科意大利血液病部门诊断出真菌血症。方法：在研究期间，我们记录了215例真菌血流感染（BSI）。微生物学分析表明，BSI是由于17例（8%）和198例（92%）的霉菌和酵母菌，174例（81%）被确定为念珠菌属。感染是53%的霉菌和18%的酵母菌组的主要死亡原因。在多变量分析中，ECOG >= 2和感染性休克与死亡率增加显著相关，中心静脉导管（CVC）拔除对生存率有保护作用。当仅考虑念珠菌血症患者时，ECOG >= 2和CVC的去除与总体mortals.Conclusions统计学相关：虽然念珠菌血症代表一组预后良好的BSI，其危险因素在很大程度上与所有真菌血症的危险因素重叠，即使与其他真菌BSI相比，念珠菌相关的死亡率较低。真菌性BSI的管理仍然是一个复杂的问题，其中应关注患者和疾病特征，以解决个性化的方法。
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 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.