Risk factors for invasive pulmonary fungal infection in patients with hematological malignancies not receiving hematopoietic stem cell transplant.

Abstract

We investigated the incidence, pathogens and risk factors of invasive pulmonary fungal infection (IPFI) in patients with hematological malignancies who did not receive hematopoietic stem cell transplantation (HSCT). Of the 323 patients included, 106 had confirmed IPFI, 111 had pulmonary bacterial infections, and 106 did not have pulmonary infections. The risk factors for IPFI were explored through logistic univariate and multivariate analysis. The incidence of IPFI in patients with hematological malignancies but without HSCT was 3.5%. The leading pathogen was Candida albicans which accounted for 50.7% of the infections, and the second one was Aspergillus which accounted for 37.3% of the infections. The main risk factors for these patients were days of hospitalization, history of IPFI, agranulocytosis, concomitant hypoproteinemia, number of antibiotics being used, concomitant bacterial sepsis, and age. Furthermore, Nystatin mouthwash was protective against IPFI. Among patients with hematological malignancies, IPFI causes the highest proportion of deaths. We have identified two important pathogens and several risk factors as well as one factor protective against IPFI. Awareness of risk factors and reduction of pathogens can decrease the incidence of IPFI.