Research Information System
Thesis Type: Expertise In Medicine
Institution Of The Thesis: Gazi Üniversitesi, Tıp Fakültesi, Turkey
Approval Date: 2015
Student: YEŞİM YILDIZ
Supervisor: ESİN ŞENOL
Abstract:Invasive fungal infections (IFI) are one of the important infectious associative morbidity and mortality reason in patients who have hemathological malignancy or stem cell transplantation therapy. Exposure of intensive cytotoxic chemotherapy, stem cell transplantation therapy, myeloablative radiotherapy, high dose corticosteroids, cylosporine and new immunsupresant agents increases IFI risk via disrupting the host protection mechanisms. Main pathogens are aspergillus and candida species in IFI. Recently incidence of some pathogens which are more difficult to treat and associated with higher mortality increased. The epidemiology of IFI varies between different geographical regions.and different madical centres. In this respect, each center has to determine their own invasive fungal disease spectrum, systemic antifungal prophylaxis and antifungal treatment approach. Our study is a single-center, observational registry study that aimed to evaluate IFI spectrum and practical use of antifungal agents in the group of inpatient stem cell transplant recipients and/or chemotherapy and immunosuppressive therapy receiving hematological malignancy patients who developed IFI, that requiring treatment doses of antifungal medications. Between May 2013 and March 2015; there were 793 inpatient admissions made in hematology and stem cell transplantation units of our medical center and systemic antifungal treatment was given to 72 inpatient episodes. One of an antifungal medication in treatment dose initiated to patients and data from the treatment were recorded. Patients who were recorded followed for 21 days. Each antifungal therapy episode were separately recorded in the same patient. Datas between May 2013- June 2014 were recorded retrospectively from medical records and hospital information management system and between June 2014- March 2015 datas were recorded prospectively. Who decided the drug choice, treatment options and examination types were not excist in the researchers group. Variables related to demographic characteristics and clinical parameters were analyzed with using descriptive and comparative statistics. Categorizing data type variables (qualitative) were noted in frequencies. For numeric data types (quantitative), if it is appropriate to the normal distribution we noted in the mean ± standard deviation; if it is not normally distributed than we noted in median (min-max) values. Categorical variables are specified as a percentage and frequency. Kolmogorov Smirnov test was used to determine whether the variables fit the normal distribution. Non parametric tests were used for variables that are not normally distributed. If the vaiables are categorical chi square test, if it is numeric bonferroni corrected Mann Whitney U test was used to evaluate the subgroup analyzis. The relationship between the variables evaluated by Spearman correlation analysis, P <0.05 was considered statistically significant. SPSS 20.0 software package was used in the preparation of statistical analyzes performed in this study. Thirty seven of the patients are men and 35 are women with a mean age of 43.4 (19-72) were detected in patients who developed IFI. 48.6% were acute myeloid leukemia (AML) ( 35 patients) and 20,8% were acute lymphoblastic leukemia (ALL) (15 patients) in this 72 episodes. Fungal episodes occured in patients who received chemoterapy; 45,8% for the purpose of induction, 34.7 % for relaps. Twenty eight of the episodes (38.9%) were possible IFI, 8 of them (11.1%) were probable IFI, 14 of them (19.4%) were proven IFI and 22 of them (30.6%) were defined as fever of unknown origin. The main pathogen that 71,4% rate of isolated in proven episodes were candida species. One patient had a Rhizopus scapula osteomyelitis, one had Fusarium spp. septisemia, Aspergillus spp. were detected in one patient's bronchoalveolar lavage ( BAL) and other's abdominal subcutaneous abscess. Primary antifungal treatments initiated; 29/72 ampiric, 38/72 preemptive and 5/72 targeted. It was detected that lung was the main focus to develop IFI (59.7%) Fifty seven episodes resulted with survival, 45 (78.9%) of them had a complete response to the 21th day of antifungal therapy evaluation. Probabale fungal infection group (21; 46.7%) and fever of unknown origin group (18; 40 %) form this 45 patient of complete response group. Treatment failure were seen in proven invasive fungal infection group with 40% rate. The main choice of primary antifungal treatment is caspofungine (55.6%) had 44.5% treatment success rate at the 21th day of antifungal therapy evaluation. At the end of the study 20.8% of 72 episodes resulted with mortality. Recently, high potential and proven invasive fungal infections declined in numbers, thanks to use of antifungal prophylaxis in the induction of AML, myelodysplastic syndrome (MDS) and allogenic stem cell transplantation (ASCT) receiver but cumulative use of antifungal agents have not achieved a reduction. One of the cause of this situation comes to mind that requirements of antifungals in prolonged febrile neutropenia episodes. As a result; each center ought to evaluate the incidence of IFI from their patients and decide which treatment strategy is more useful for their patients. Eventhough empirical therapy is started in high risky patients; a "dynamic" approach is considered to be appropriate for our own center that trying to get evidence in early stages with diagnostic tools and termination of the treatment in unnecessary situations.