Infection Characteristics In 375 Patients With Hematological Malignancies And Invasive Fungal Diseases

Objective:To investigate the clinical characteristics of patients with hematological malignancies are complicated with invasive fungal disease in Qinghai province,so as to explore the possible risk factors of invasive fungal infection with hematological malignancies in Qinghai province and the choice of antifungal therapy,the aim is to provide a guideline for early diagnose of the disease and to explore the cure to prevent Invasive Fungal Disease.Methods:A retrospective analysis of 375 cases of patients with hematology at the Affiliated Hospital of Qinghai University and specific diagnosis of hematological malignancies from January 2012 to December 2016 was retrospectively analyzed.All patients were collected for gender,age,and disease,bone marrow transplantation,antibiotic used and duration of use,imaging findings and other related indicators,according to whether the merger fungal infection is divided into invasive fungal disease.134 patients in the disease group and 241 patients without the fungal infection group were analyzed.All the risk factors of invasive fungal disease were analyzed.Results:Among the 375 patients with hematological malignancies,134 patients had invasive fungal infection with most of them include acute leukemia.1 case was diagnosed as fungemia,accounting for 0.7%;17 cases were diagnosed clinically,accounting for 12.7%;66 cases were suspected fungal diseases.accounting as 49.3%;50 cases were undetermined fungal diseases,accounting for 37.3%.There were 126 cases of pulmonary infection(accounting for 94.0%),6 cases of intestinal infection(4.5%)and 2 blood infection(1.5%).375 cases of patients with hematological malignancies,their blood culture was sent 186 times,1 fungus Candida albicans,blood culture positive detection rate of 0.54%.and 235 times body fluid samples was cultured and susceptible.64 strains were detected.130 cases of high-resolution chest CT,imaging findings with multiple patchy shadows and flocculent exudative shadow,one case of specific wedge-shaped,one case of cloud or crescent sign.Univariate analysis showed that age,primary outcome,catheterization of deep veins,use of Glucocorticoid,duration of neutropenia,type of antibiotic use,hypoproteinemia,duration of antibiotic use,combined bacterial infection,immunosuppressive agents,catheterization,the infection of Epstein-Barr virus or cytomegalovirus,The proportions of 12 factors were statistically significant(p <0.05).Multivariate non-conditional Logistic regression analysis showed that age ?60 years(P = 0.028,OR = 0.267)catheterization of deep veins(p = 0.034,OR = 0.067),bacterial infection(p = 0.012,OR = 10.175),hypoproteinemia(p = 0.018,OR = 0.235)(p = 0.017,OR = 0.192),duration of persistent laryngeal lesions?7days(p = 0.003,OR = 0.142),type of antibiotics used?2(p = 0.000,OR = 0.069)The use of duration ?7days(p = 0.002,OR = 0.063)was an independent risk factor for combined invasive fungal disease.Of the 132 patients who received antifungal therapy,23 patients had adverse reactions related to fungal therapy,101 were preferred Voriconazole,11 patients had adverse reactions related to voriconazole such as blurred vision and illusion,and 15 were switched to other antifungal agents.Conclusion: 1.Malignant hematological diseases with invasive fungal disease are mainly acute leukemia,and pulmonary infection is more common at the infected sites.2.IFD diagnosis is low.Clinical diagnosis of IFD is based on pathogenic microbiological examination,Candida as the main pathogens,Chest CT also as an important basis for the diagnosis of early IFD.3.The independent risk factors for IFD were age ?60 years old,the primary disease did not alleviate PICC catheter,Glucocorticoid duration of use> 5 days,duration of neutropenia persistence?7 days,antibiotic use?2,duration of antibiotics?7 days,Bacterial infection,hypoalbuminemia nine factors.It should pay attention to the clinical control of Glucocorticoid and broad-spectrum antibiotics,the existence of patients with granular defects should be closely monitored for early detection of fungal infections.4.Clinical antifungal therapy preferred Fluconazole and Voriconazole.Candida is highly sensitivity to Voriconazole,the most common adverse reactions with Voriconazole are blurred vision and visual hallucinations.