Abstract
Background
Invasive fungal infections are a leading cause of death in allo-HSCT (allogenic hematopoietic stem cell transplant) recipients. We describe the epidemiology of IFIs (invasive fungal infections) in allo-HSCT recipients at a single institution in Salt Lake City, Utah between 2006 and 2015.
Methods
We searched all encounters in the Intermountain Healthcare electronic medical record from 2006 to 2015 for clinical data associated with IFIs in allo-HSCT recipients. EORTC-MSG definitions were applied to categorize IFI as proven, probable, or possible. Linear regression was used to model the variation in incidence over time.
Results
326 unique allo-HSCT were performed; of these 114 episodes of IFI occurred in 105 patients. Mean incidence was 35.9 IFI per 100 transplants, and increased by 2.3 IFI cases/100 transplants per year. 25.4% of cases were classified as proven; 47.4% as probable and 19.3% as possible. Invasive Aspergillus represented the majority of cases (62.3%), followed by non-specified (in most cases positive imaging and a positive β-d-glucan, 18%), Candidiasis (10%), and Mucorales (3.5%). The median age was 50 years, range 22 to 73, with males representing 52.6% of cases. The most common non-hematologic comorbidities were chronic pulmonary disease (42.9%), chronic heart failure (32.4%), and hepatic disease (31.4%). 48.6% of patients received matched unrelated allo-HSCT, 34.3% received matched sibling donor allo-HSCT, 14.3% received haploidentical allo-HSCT, and 3% received cord allo-HSCT. 79% of transplants were myeloablative. Median time from transplant to onset of IFI was 145 days (95% CI 39–259). The median time to onset of Aspergillosis was 120 days (95% CI 34–241 days), Candidiasis was 130 days (95% CI 12–283 days), and Mucorales was 246 days (95% CI 126–338 days). Active GVHD was present in 60% of IFI cases. 63% of cases were on antifungal prophylaxis, most commonly an echinocandin. All-cause mortality was 30.5% at 42 days and 65.7% at 1 year. The median time to death from the onset of IFI was 68.5 days.
Conclusion
IFIs are common in allo-HSCT recipients and appear to be increasing in frequency. Further work is needed to risk-stratify patients, determine optimal prophylaxis and empiric treatment, and define resistance trends.
Disclosures
All authors: No reported disclosures.
Invasive Fungal Infections in Patients with Acute Leukemia and Hematopoietic Stem Cell Transplant Recipients
