Cheong Chin Sum, Iyadorai Thevambiga, Tay Sun Tee, Liong Chee Chiat, Hussein Najihah, Samudi Chandramathi, Velayuthan Rukumani, Bee Ping Chong, Chin Edmund Fui Min, Khairullah Shasha, Zamri Yazid, Gan Gin Gin
Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
Asian Pac J Cancer Prev. 2025 Mar 1;26(3):839-845. doi: 10.31557/APJCP.2025.26.3.839.
This study aims to describe the incidence and risk factors of invasive fungal infection (IFI) among patients with haematological malignancies (HM) in a tertiary hospital from Malaysia.
This was a cross-sectional study in a teaching hospital involving HM patients, admitted for chemotherapy or haematopoietic stem cell transplantation (HSCT). Each admission for either chemotherapy or HSCT was considered as a separate event. Patients were followed up for development of IFI from the time of each admission to time of discharge or time of death. Outcomes of patients with IFI upon discharge were recorded. Clinical and mycological data during each admission were collected and analysed.
Eighty-three patients with mean age of 58.8±15.5 years were recruited. Acute myeloid leukemia (AML) was the most common diagnosis (45.8%). A total of 132 admissions were analysed from these 83 patients. Antifungal prophylaxes were prescribed in 94.7% of admissions with fluconazole being the most common agent used (88.6%). The incidence of proven and probable IFI was 7.6%. Candida tropicalis was the most common fungi isolated from these patients (22.7%), followed by Candida krusei (13.6%). The mortality rate due to IFI was 17.6%. Patients with AML and those with concomitant bacteraemia were associated with higher risk of IFI (odds ratio [OR] 3.69, 95% confidence interval [CI] 1.16-11.71, p=0.029 and OR 4.17, 95% CI 1.37-12.66, p=0.009, respectively), while the use of antifungal prophylaxis was associated with lower IFI risk (OR 0.17, 95% CI 0.03-0.83, p=0.045). After multivariate analysis, the use of antifungal prophylaxis remains significantly associated with lower risk of IFI (OR 0.54, 95% CI 0.01-0.62, p=0.019).
IFI remains one of serious complications of HM patients undergoing chemotherapy and HSCT, most commonly due to non-albicans Candida spp. Appropriate antifungal prophylaxis is therefore crucial in the prevention of breakthrough IFI.
本研究旨在描述马来西亚一家三级医院血液系统恶性肿瘤（HM）患者侵袭性真菌感染（IFI）的发病率及危险因素。
这是一项在教学医院开展的横断面研究，纳入因化疗或造血干细胞移植（HSCT）入院的HM患者。每次化疗或HSCT入院均视为一个独立事件。从每次入院至出院或死亡，对患者进行IFI发生情况的随访。记录IFI患者出院时的结局。收集并分析每次入院期间的临床和真菌学数据。
招募了83例平均年龄为58.8±15.5岁的患者。急性髓系白血病（AML）是最常见的诊断（45.8%）。对这83例患者共分析了132次入院情况。94.7%的入院患者接受了抗真菌预防治疗，其中氟康唑是最常用的药物（88.6%）。确诊和拟诊IFI的发病率为7.6%。热带念珠菌是从这些患者中分离出的最常见真菌（22.7%），其次是克柔念珠菌（13.6%）。IFI导致的死亡率为17.6%。AML患者和合并菌血症的患者发生IFI的风险较高（优势比[OR]分别为3.69，95%置信区间[CI]1.16 - 11.71，p = 0.029；以及OR 4.17，95% CI 1.37 - 12.66，p = 0.009），而使用抗真菌预防治疗与较低的IFI风险相关（OR 0.17，95% CI 0.03 - 0.83，p = 0.045）。多因素分析后，使用抗真菌预防治疗仍与较低的IFI风险显著相关（OR 0.54，95% CI 0.01 - 0.62，p = 0.019）。
IFI仍然是接受化疗和HSCT的HM患者的严重并发症之一，最常见的原因是非白色念珠菌属。因此，适当的抗真菌预防对于预防突破性IFI至关重要。
