Analysis Of The Risk Factors Of Invasive Fungal Disease Related To Hematologic Malignancies

Objective: To investigate the related risk factors and clinical features of malignant hematologic diseases with invasive fungal infection,and to provide guideline for the early diagnosis of invasive fungal disease.Methods: A retrospective review of 192 in-patients who were diagnosed with hematological malignancies from Jan 2013 and Jan 2016.Patients were divided into two groups,97 cases with fungal infection in case group,97 cases without fungal infection as the control group.And then collect related indicators and analyze related risk factors.Single factor analysis was performed by c2 test,unconditional logistic regression analysis was used to analyze multivariate factor.Statistics were analyzed using SPSS 17.0 software.Results: Among the 97 patients of malignant hematologic malignancy with invasive fungal disease,clinical diagnosis accounted for 64.9%(63/97),the suspected diagnosis30.9%(30/97),4.2%/(4/97)were diagnosed with fungemia.In addition,acute leukemia(57.7%)is the most common type of hematologic disease.Fungus infection is characterized by a lack of special symptom and clinical manifestations,and the site of fungus infection variable.Lung is the main site of infection,accounting for 78.3%(76/97).Chest CT shown that 26 cases of pulmonary fungus infection displayed specific changes,multiple pulmonary nodules with patchy high density shadow accounted for 50%(13/26),in which 1 case displayed cavity formation and 1 case displayed ground-glass opacity.During 194 cases of malignant hematological patients hospitalization,692 samples of hemoculture and drug susceptibility were collected,among 52(48 strains bacteria and 4strains fungal)strains from 692 samples,positive rate of blood culture was 7.5%.Univariate analysis showed that the difference of age,primary disease,the duration of broad-spectrum antibiotic,the duration of neutropenia,or whether complication with hypoalbuminemia between cases group and control group were considered to bestatistically significant,(P <0.05).Multivariate unconditional logistic regression analysis showed that the primary disease not remission(P = 0.012,OR = 2.904),neutropenia ?7days(P = 0.000,OR = 3.938),and the duration of glucocorticoids ?5d(P = 0.005,OR =3.174),the duration of broad-spectrum antibiotic ? 7d(P = 0.004,OR = 2.730)were independent risk factors for malignant hematological malignancies with invasive fungal infection.Conclusions:1.Fungal infection with acute leukemia is the main type of malignant hematologic disease with invasive fungal infection.And the site of fungus infection and clinical features are distinct.Microbiological analysis is the main basis for the diagnosis of invasive fungal disease.However,due to the low positive rate of blood culture and the detective rate of fungi,leading to the low diagnosis rate of invasive fungal disease.It mainly diagnosis by clinical diagnosis and Candida spp are the main pathogens.2.Primary disease not remission,the length of broad-spectrum antibiotics therapy,the duration of neutropenia,and the dosage of corticosteriods are involved in the occurrence of invasive fungal infection with malignant hematologic.In clinical practice,the reasonable use of antibiotics and corticosteroids,reducing the duration of neutropenia by medicine,will help to prevent or reduce the emergence of malignant hematologic disease with invasive fungal infection.