gms | German Medical Science

Objectives: To define demographic parameters, underlying diseases, etiology, diagnostics and treatment of haematological and oncological patients with nosocomial invasive aspergillosis (IA) in St. Petersburg, Russia.

Methods: The prospective study was conducted during the period of 1998-2013 y.y. The diagnosis of IA was made according to EORTC/MSG criteria (2008). Cases of nosocomial IA were considered on the basis of WHO criteria: “nosocomial infections (hospital-acquired infections), are infections acquired during hospital care which are not present or incubating at admission, if the disease occurred more than 48 hours after admission”.

Results: During the study period 448 haematological and oncological patients with IA were observed. Proven IA cases were diagnosed in 11% of patients and probable - 89%. Nosocomial IA – 84%, out-hospital - 16%.

The mean age of patients with nosocomial IA was 35 years (range 1-74 years), male and female ratio 1:1. In the group of patients with out-hospital IA median age - 39 (range 5 - 76 years), male and female ratio 2:1.

Main underlying conditions in hematological and oncological patients with nosocomial IA and out-hospital IA were: acute myeloid and lymphoblastic leukemia than out-hospital (60% vs. 30%, p = 0.004), non-Hodgkin's lymphoma - 10% vs. 13%, Hodgkin's lymphoma – 8% vs. 20%, myeloma - 5% vs. 7%, chronic myeloid leukemia – 4% vs. 7%, chronic lymphoblastic leukemia – 4% vs. 11%, myelodysplastic syndrome - 4% vs. 2%, acute leukemia – 2% vs. 8%, aplastic anemia -1% vs. 2%, Burkitt's lymphoma – 0,4% vs. 0, hemangioblastoma – 0,4% vs. 0. We diagnosed nosocomial IA in more patients with acute myeloid and lymphoblastic leukemia than out-hospital (60% vs. 30%, p = 0.004).

Etiology of nosocomial and out-hospital IA: A. fumigatus (56% vs 42%), A. niger (30% vs 47%), A. flavus (20% vs 21%), A. ochraceus (3% vs 5%), A. terreus (2% vs 0), A. ustus (2% vs 0), A. versicolor (0 vs 5%), >2 Aspergillus spp. – 14% vs . 21%.

Lungs were involved in 95% of patients in both groups, sinusitis (7% vs. 4%), cerebral form (4% vs. 4%) and gastrointestinal (1% vs. 0), endophthalmitis - 1% vs. 0, two or more organs - 8% vs. 4%. GM in serum was positive in 73% vs. 68% of cases. Direct microscopic examination of BAL, sputum, CSF and sinuses aspirate was positive in 27% vs. 43% of cases.

Antifungal therapy was performed all of patients: voriconazole (71% vs. 54%), amphotericin B deoxycholate (38% vs. 38%), itraconazole (34% vs. 40%), caspofungin (20% vs. 27%), posaconazole (7% vs. 8%), amphotericin B lipid complex (5% vs. 4%). Combination therapy was used for 10% vs. 4% of patients. Duration of treatment 2 to 277 days (median - 49) vs. 2 to 420 days (median - 70). Overall survival at 12 weeks was 80% vs. 88%.

Conclusions: In hematological and oncological patients IA was nosocomial infection in 84% of cases. The main underlying conditions of nosocomial IA - acute myeloid and lymphoblastic leukemia (60% vs. 30%). Main pathogens of nosocomial IA were A. fumigatus, out-hospital IA - A. niger. 12 weeks overall survival of patients with nosocomial IA was 80% vs. 88%.