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Invasive Fungal Infections Among Ventilated HSCT Patients in the ICU

February 22, 2012

Invasive fungal infection (IFI) is associated with high morbidity and high mortality in hematopoietic stem cell transplantation (HSCT) patients. Chen-Yiu Hung, of the Department of Thoracic Medicine at Chang Gung Memorial Hospital in Taipei, Taiwan, and colleagues, sought to assess the characteristics and outcomes of HSCT patients with IFIs who are undergoing mechanical ventilation (MV) at a single institution in Taiwan.   The researchers  performed an observational retrospective analysis of IFIs in HSCT patients undergoing MV in an intensive care unit (ICU) from 2000 to 2009. The characteristics of these HSCT patients and risk factors related to IFIs were evaluated. The status of discharge, length of ICU stay, date of death and cause of death were also recorded.   There were 326 HSCT patients at the Linkou Chang-Gung Memorial Hospital (Taipei, Taiwan) during the study period. Sixty of these patients (18 percent) were transferred to the ICU and placed on mechanical ventilators. A total of 20 of these 60 patients (33 percent) had IFIs. Multivariate analysis indicated that independent risk factors for IFI were admission to an ICU more than 40 days after HSCT, graft versus host disease (GVHD), and high dose corticosteroid (p < 0.01 for all). The overall ICU mortality rate was 88 percent (53 of 60 patients), and was not significantly different for patients with IFIs (85 percent) and those without IFIs (90 percent, p = 0.676).

Invasive fungal infection (IFI) is associated with high morbidity and high mortality in hematopoietic stem cell transplantation (HSCT) patients. Chen-Yiu Hung, of the Department of Thoracic Medicine at Chang Gung Memorial Hospital in Taipei, Taiwan, and colleagues, sought to assess the characteristics and outcomes of HSCT patients with IFIs who are undergoing mechanical ventilation (MV) at a single institution in Taiwan.
 
The researchers  performed an observational retrospective analysis of IFIs in HSCT patients undergoing MV in an intensive care unit (ICU) from 2000 to 2009. The characteristics of these HSCT patients and risk factors related to IFIs were evaluated. The status of discharge, length of ICU stay, date of death and cause of death were also recorded.
 
There were 326 HSCT patients at the Linkou Chang-Gung Memorial Hospital (Taipei, Taiwan) during the study period. Sixty of these patients (18 percent) were transferred to the ICU and placed on mechanical ventilators. A total of 20 of these 60 patients (33 percent) had IFIs. Multivariate analysis indicated that independent risk factors for IFI were admission to an ICU more than 40 days after HSCT, graft versus host disease (GVHD), and high dose corticosteroid (p < 0.01 for all). The overall ICU mortality rate was 88 percent (53 of 60 patients), and was not significantly different for patients with IFIs (85 percent) and those without IFIs (90 percent, p = 0.676).

The researchers concluded that there was a high incidence of IFIs in HSCT patients requiring MV in the ICU in their study cohort. The independent risk factors for IFI are ICU admission more than 40 days after HSCT, GVHD, and use of high-dose corticosteroid. Their research was published in BMC Infectious Diseases.

Reference: Hung C-Y, et al. Invasive fungal infection among hematopoietic stem cell transplantation patients with mechanical ventilation in the intensive care unit. BMC Infectious Diseases 2012, 12:44 doi:10.1186/1471-2334-12-44