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Invasive fungal infection among hematopoietic stem cell transplantation patients with mechanical ventilation in the intensive care unit.

Hung CY, Kao KC, Wang PN, Hu HC, Hsieh MJ, Fu JY, Chang CH, Li LF, Huang CC, Tsai YH, Yang CT - BMC Infect. Dis. (2012)

Bottom Line: Invasive fungal infection (IFI) is associated with high morbidity and high mortality in hematopoietic stem cell transplantation (HSCT) patients.The status of discharge, length of ICU stay, date of death and cause of death were also recorded.Sixty of these patients (18%) were transferred to the ICU and placed on mechanical ventilators.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.

ABSTRACT

Background: Invasive fungal infection (IFI) is associated with high morbidity and high mortality in hematopoietic stem cell transplantation (HSCT) patients. The purpose of this study was to assess the characteristics and outcomes of HSCT patients with IFIs who are undergoing MV at a single institution in Taiwan.

Methods: We performed an observational retrospective analysis of IFIs in HSCT patients undergoing mechanical ventilation (MV) in an intensive care unit (ICU) from the year 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.

Results: There were 326 HSCT patients at the Linkou Chang-Gung Memorial Hospital (Taipei, Taiwan) during the study period. Sixty of these patients (18%) were transferred to the ICU and placed on mechanical ventilators. A total of 20 of these 60 patients (33%) 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% (53 of 60 patients), and was not significantly different for patients with IFIs (85%) and those without IFIs (90%, p = 0.676).

Conclusion: There was a high incidence of IFIs in HSCT patients requiring MV in the ICU in our study cohort. The independent risk factors for IFI are ICU admission more than 40 days after HSCT, GVHD, and use of high-dose corticosteroid.

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Related in: MedlinePlus

Diagnostic categories and characteristics of patients with invasive fungal infections.
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Figure 1: Diagnostic categories and characteristics of patients with invasive fungal infections.

Mentions: The average time of IFI diagnosis was four days after ICU admission and the range was one to seven days. Figure 1 shows the diagnostic categories and characteristics of the 20 IFI patients. Four patients had proven IFIs, and 3 of these patients had Aspergillus and 1 patient had Candida. Eleven patients had probable IFIs, and 4 of these patients had Aspergillus, 5 patients had Candida, and 2 patients had other fungi. Five patients had possible IFIs, and all 5 patients had Aspergillus.


Invasive fungal infection among hematopoietic stem cell transplantation patients with mechanical ventilation in the intensive care unit.

Hung CY, Kao KC, Wang PN, Hu HC, Hsieh MJ, Fu JY, Chang CH, Li LF, Huang CC, Tsai YH, Yang CT - BMC Infect. Dis. (2012)

Diagnostic categories and characteristics of patients with invasive fungal infections.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3298694&req=5

Figure 1: Diagnostic categories and characteristics of patients with invasive fungal infections.
Mentions: The average time of IFI diagnosis was four days after ICU admission and the range was one to seven days. Figure 1 shows the diagnostic categories and characteristics of the 20 IFI patients. Four patients had proven IFIs, and 3 of these patients had Aspergillus and 1 patient had Candida. Eleven patients had probable IFIs, and 4 of these patients had Aspergillus, 5 patients had Candida, and 2 patients had other fungi. Five patients had possible IFIs, and all 5 patients had Aspergillus.

Bottom Line: Invasive fungal infection (IFI) is associated with high morbidity and high mortality in hematopoietic stem cell transplantation (HSCT) patients.The status of discharge, length of ICU stay, date of death and cause of death were also recorded.Sixty of these patients (18%) were transferred to the ICU and placed on mechanical ventilators.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.

ABSTRACT

Background: Invasive fungal infection (IFI) is associated with high morbidity and high mortality in hematopoietic stem cell transplantation (HSCT) patients. The purpose of this study was to assess the characteristics and outcomes of HSCT patients with IFIs who are undergoing MV at a single institution in Taiwan.

Methods: We performed an observational retrospective analysis of IFIs in HSCT patients undergoing mechanical ventilation (MV) in an intensive care unit (ICU) from the year 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.

Results: There were 326 HSCT patients at the Linkou Chang-Gung Memorial Hospital (Taipei, Taiwan) during the study period. Sixty of these patients (18%) were transferred to the ICU and placed on mechanical ventilators. A total of 20 of these 60 patients (33%) 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% (53 of 60 patients), and was not significantly different for patients with IFIs (85%) and those without IFIs (90%, p = 0.676).

Conclusion: There was a high incidence of IFIs in HSCT patients requiring MV in the ICU in our study cohort. The independent risk factors for IFI are ICU admission more than 40 days after HSCT, GVHD, and use of high-dose corticosteroid.

Show MeSH
Related in: MedlinePlus