Evaluation of risk factors in the development of invasive fungal infections in immunosupressive patients retrospectively

Invasive fungal infections (IFI) in immunocompromised patients, the incidence of morbidity and mortality is increasing. The aims of study is to compare the types and the distribution of IFI; to determine the probable risk factors in the development of IFI; and to assess the mortality and underlying diseases among patients with hematological malignancies and non-hematological immunosuppressive patients. Eightyfour adult patients with the diagnosis of IFI in between January 1st, 2012 and April 1st, 2014 at Başkent University Hospital were enrolled in this retrospective study. The identification and classification of each case was performed according to the revised definitions of IFI from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) consensus group. According to these revised criterias with the exception of endemic mycoses IFI cases were evaluated as three groups "proven", "probable", "possible". All data obtained was transferred to Statistical Package for the Social Sciences (SPSS ®) 11 (SPSS Inc., Chicago, IL, USA ®). Pearson's chi-square test and Mann-Whitney was used for comparison of variables. In all analyzes, p <0.05 was considered to be statistical significance level. The distribution of cases were documented as: 58 proven IFI (69.0%), 12 possible IFI (14.2%), 14 possible IFI (16.6%). The distribution of the patients with proven IFI were as follows: 91.3% invasive candidiasis (53/58) (52 candidemia and one candidal mediastinitis ) and 5.1% pulmonary aspergillosis (3/58). In addition, nasopharyngeal invasive fungal involvement (1/58, 1.7%) and invasive fungal involvement in the colon (1/58, 1.7%) in two separate cases were documented. All cases of probable and possible IFE (26/26, 100%) were determined as pulmonary aspergillosis. The previously known risk factors for the development of IFI; immunosuppressive drug usage, renal replacement therapy requirement, mechanical ventilation requirement, presence of central venous catheter, presence of urinary catheter, presence of gastrointestinal catheter, mucositis / diarrhea / ileus history, malnutrition, transfusion of blood product, bacterial infection, antibacterial treatment, length of stay in hospital and intensive care unit, duration of neutropenia were evaluated for both groups. The immunosuppressive drug usage and the duration of neutropenia were found to be statistically significant between the hematologic malignancy and non-hematologic immunosuppressive groups. The common risk factors, except these two factors, were not found to be statistically significant between these two groups (p <0.05). Our findings are in accordance with the literature, but the high mortality rate in invasive candidiasis patient group drives attention. This study also shows that the epidemiology of IFI may vary on regional and patient bases. Even though the data set has its own limitations such as the data belongs to the patients applied to a single hospital, this study is still one of the rare studies on this mere subject. The studies on the same topic will enlighten IFI epidemiology and the variations between the hematologic and non-hematologic based patient groups. Need to have a better understanding of risk factors of common sensed invasive fungal infections and need to gain extensive usage of new developed diagnostic methods and multidisciplinary approach has to be maintained.