Monzo-Gallo Patricia, Teijon-Lumbreras Christian, Aiello Tommaso Francesco, Gallardo-Pizarro Antonio, Martinez-Urrea Ana, Chumbita Mariana, Gras Emmanuelle, Peyrony Olivier, Bodro Marta, Magnano Laura, Herrera Sabina, Suarez-Lledó Maria, Espasa Mateu, Marco Francesc, Soriano Alex, Garcia-Vidal Carolina
Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain.
Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain.
Med Mycol. 2025 Aug 5;63(8). doi: 10.1093/mmy/myaf070.
We aim to describe the epidemiology and risk factors for invasive fungal infections (IFI) and invasive mould infections (IMI) in hospitalized hematologic patients within the context of current hematologic therapies. Retrospective observational cohort study conducted on consecutive hematologic patients admitted to a tertiary hospital (2020-2023). Two populations were analysed: the full cohort of hospitalized patients (FC) and the subset of patients for whom mycological testing was specifically requested to rule out an IFI (SC). Proven or probable IFI was classified using European Organization for Research and Treatment of Cancer criteria. Risk factors for IFI and IMI were identified. A total of 1975 patients were included in the FC, whereas 1154 were included in the SC. IFI was diagnosed in 64 patients (65 episodes), and IMI in 43 patients (44 episodes). Aspergillosis was the most common IFI (58.4%), followed by candidemia (18.5%), Pneumocystis jirovecii pneumonia (PJP) (15.4%), mucormycosis (6.2%), and fusariosis (4.6%). Independent risk factors for IFI in the FC included acute leukemia (aOR 2.40, 95% CI 1.37-4.10, P = .002), corticosteroid use (aOR 2.36, 95% CI 1.40-4.03, P = .001) and graft versus host disease (GVHD) (aOR 2.13, 95% CI 0.93-4.46, P = .05). For IMI, risk factors were acute leukemia (aOR 2.71, 95% CI 1.33-5.52, P = .006), corticosteroid use (aOR 1.96, 95% CI 0.98-4.03, P = .05) and chronic lung disease (aOR 2.25, 95% CI 1.06-4.5, P = .02). In the SC, corticosteroid use (aOR 2.45, 95% CI 1.44-4.25, P = .001) was the independent risk factor for IFI, and corticosteroid use (aOR 2.40, 95% CI 1.21-4.91, P = .01) and GVHD (aOR 2.95, 95% CI 1.23-6.52, P = .009) were independent factors associated with IMI. Mortality was significantly higher in IFI patients compared to non-IFI patients (51.6% vs. 20.3%, P < .001). In this new era of haematology, the epidemiology of IFI is shifting, with Pneumocystis, Mucorales, and Fusarium becoming more prevalent. While corticosteroids and GVHD remain key risk factors, factors such as chronic lung disease are increasing its importance. Prolonged neutropenia may have decreased in relevance, likely due to prophylaxis. Preventing PJP has become a new challenge in IFI management.
我们旨在描述在当前血液学治疗背景下，住院血液病患者侵袭性真菌感染（IFI）和侵袭性霉菌感染（IMI）的流行病学及危险因素。对一家三级医院收治的连续血液病患者（2020 - 2023年）进行回顾性观察队列研究。分析了两个人群：住院患者全队列（FC）和专门要求进行真菌学检测以排除IFI的患者亚组（SC）。采用欧洲癌症研究与治疗组织标准对确诊或疑似IFI进行分类。确定了IFI和IMI的危险因素。FC纳入了1975例患者，SC纳入了1154例患者。64例患者（65次发作）诊断为IFI，43例患者（44次发作）诊断为IMI。曲霉病是最常见的IFI（58.4%），其次是念珠菌血症（18.5%）、耶氏肺孢子菌肺炎（PJP）（15.4%）、毛霉病（6.2%）和镰刀菌病（4.6%）。FC中IFI的独立危险因素包括急性白血病（调整后比值比[aOR] 2.40，95%置信区间[CI] 1.37 - 4.10，P = 0.002）、使用皮质类固醇（aOR 2.36，95% CI 1.40 - 4.03，P = 0.001）和移植物抗宿主病（GVHD）（aOR 2.13，95% CI 0.93 - 4.46，P = 0.05）。对于IMI，危险因素为急性白血病（aOR 2.71，95% CI 1.33 - 5.52，P = 0.006）、使用皮质类固醇（aOR 1.96，95% CI 0.98 - 4.03，P = 0.05）和慢性肺病（aOR 2.25，95% CI 1.06 - 4.5，P = 0.02）。在SC中，使用皮质类固醇（aOR 2.45，95% CI 1.44 - 4.25，P = 0.001）是IFI的独立危险因素，使用皮质类固醇（aOR 2.40，95% CI 1.21 - 4.91，P = 0.01）和GVHD（aOR 2.95，95% CI 1.23 - 6.52）是与IMI相关的独立因素。IFI患者的死亡率显著高于非IFI患者（51.6%对20.3%，P < 0.001）。在这个血液学的新时代，IFI的流行病学正在发生变化，肺孢子菌、毛霉目和镰刀菌变得更加普遍。虽然皮质类固醇和GVHD仍然是关键危险因素，但慢性肺病等因素的重要性正在增加。长期中性粒细胞减少症的相关性可能由于预防措施而降低。预防PJP已成为IFI管理中的一项新挑战。
