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Open Access Highly Accessed Research article

Invasive fungal infection among hematopoietic stem cell transplantation patients with mechanical ventilation in the intensive care unit

Chen-Yiu Hung123, Kuo-Chin Kao123, Po-Nan Wang4, Han-Chung Hu123, Meng-Jer Hsieh123, Jui-Ying Fu123, Chih-Hao Chang123, Li-Fu Li123, Chung-Chi Huang123, Ying-Huang Tsai123 and Cheng-Ta Yang123*

Author Affiliations

1 Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan

2 Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan

3 Department of Respiratory Care, Chang-Gung University College of Medicine, Taipei, Taiwan

4 Division of Hematology-Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan

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BMC Infectious Diseases 2012, 12:44  doi:10.1186/1471-2334-12-44

Published: 18 February 2012

Abstract

Background

Invasive fungal infection (IFI) is associated with high morbidity and high mortality in hematopoietic stem cell transplantation (HSCT) patientsThe purpose of this study was to assess the characteristics and outcomes of HSCT patients with IFIs who are undergoing MV at a single institution in Taiwan.

Methods

We performed an observational retrospective analysis of IFIs in HSCT patients undergoing mechanical ventilation (MV) in an intensive care unit (ICU) from the year 2000 to 2009. The characteristics of these HSCT patients and risk factors related to IFIs were evaluated. The status of discharge, length of ICU stay, date of death and cause of death were also recorded.

Results

There were 326 HSCT patients at the Linkou Chang-Gung Memorial Hospital (Taipei, Taiwan) during the study period. Sixty of these patients (18%) were transferred to the ICU and placed on mechanical ventilators. A total of 20 of these 60 patients (33%) had IFIs. Multivariate analysis indicated that independent risk factors for IFI were admission to an ICU more than 40 days after HSCT, graft versus host disease (GVHD), and high dose corticosteroid (p < 0.01 for all). The overall ICU mortality rate was 88% (53 of 60 patients), and was not significantly different for patients with IFIs (85%) and those without IFIs (90%, p = 0.676).

Conclusion

There was a high incidence of IFIs in HSCT patients requiring MV in the ICU in our study cohort. The independent risk factors for IFI are ICU admission more than 40 days after HSCT, GVHD, and use of high-dose corticosteroid.

Keywords:
Invasive fungal infection (IFI); Hematopoietic stem cell transplantation (HSCT); Intensive care unit (ICU); Outcome assessment; Risk factor