The electronic surveillance system
Hema e-Chart allowed us to prospectively collect data and to perform an analysis of
invasive fungal infections (IFI) diagnosed in febrile patients as well as the procedures allowing their diagnosis and outcome according to the treatment given. Every patient admitted to 26 Italian Haematology Units with a new diagnosis of haematological
malignancy and who was a candidate for
chemotherapy was consecutively registered between March 2007 and March 2009. In all, 147 haematological patients with
mycoses were identified. Yeasts were found in 23
infections; moulds were diagnosed in 17 proven, 35 probable and 72 possible
mycoses.
Galactomannan (GM)
antigen was the most important test to diagnose probable mould
infection; it was positive (cut-off >0.5) in 27 (77%) probable and in nine (53%) proven mould
infections. Among patients with probable/proven mould
infection who received no prophylaxis or non-mould-active prophylaxis with
fluconazole, more patients (n = 26, 78.8%) had GM
antigen positivity compared with patients (n = 10, 52.6%) given prophylaxis with mould-active drugs (p <0.05). First-line antifungal
therapy was effective in 11/23 (48%) yeast
infections and in 37/52 (71.2%) proven/probable mould
infections. Twenty patients (14%) died within 12 weeks. The fungal attributable mortality was 30.4% and 17.3% in yeast and proven/probable mould
infections, respectively. Among risk factors only age was independently associated (p 0.013) with mortality; sex, underlying haematological
malignancy, previous prophylaxis and presence of
neutropenia at diagnosis were not significant. A diagnosis of mould
infection seemed to have a trend for a better outcome than the diagnosis of yeast
infection (p 0.064).