1.Determination of Risk Factors for Infectious Diarrhea in Patients with Hematological Malignancy
Şükran ŞAHINKAYA ; Zeynep TURE ; Ali UNAL ; Gamze Kalın ÜNÜVAR ; Ayşegül Ulu KILIÇ
Infection and Chemotherapy 2024;56(2):239-246
Background:
This study aimed to determine the risk factors of infectious diarrhea in patients undergoing chemotherapy or hematopoietic stem cell transplantation for hematological malignancies.
Materials and Methods:
This was a prospective, observational study. Patients in whom the infectious agent was determined by laboratory examination were considered to have infectious diarrhea. Patients with diarrhea were categorized as infectious or unidentified and compared in terms of demographic data, treatments, risk factors, laboratory findings, and prognosis.
Results:
A total of 838 patients were hospitalized, among which 105 patients who met the inclusion criteria were included (12.5%). The patients were divided into two groups: 67 (63.8%) with unidentified diarrhea and 38 (36.2%) with infectious diarrhea. There were no differences between these groups in terms of age, sex, types of hematological malignancies, and presence of comorbidities. The most commonly isolated microorganism was Clostridioides difficile (12.4%). The rate of corticosteroid use was higher in the group with infectious diarrhea (39.5%) than in the group with unidentified diarrhea (7.5%) (P <0.001). The rate of granulocyte colony-stimulating factor (GCSF) use was higher in patients with unidentified diarrhea than in patients with infectious diarrhea (67.2% vs. 42.1%, P=0.022). The median duration of diarrhea was 9 (4–10) days in the group with infectious diarrhea and 5 (3–8) days in the group with unidentified diarrhea (P=0.012). According to the multivariate logistic regression model, corticosteroid treatment increased the risk of infectious diarrhea by a 4.75-fold (95% confidence interval [CI], 1.32–17.02) times. Moreover, the duration of diarrhea may result in a 1.15 (95% CI, 1.02–1.31) fold increase in the risk of infectious diarrhea, while GCSF treatment had a 2.84 (1/0.35) (95% CI, 0.12–0.96) fold risk-reducing effect against infectious diarrhea.
Conclusion
Infectious diarrhea lasts longer than unidentified diarrhea in patients with hematological malignancies. Although corticosteroid use is a risk factor for developing infectious diarrhea, GCSF use has a protective effect.
2.The Outcome of Fungal Pneumonia with Hematological Cancer
Esma EREN ; Emine ALP ; Fatma CEVAHIR ; Tuğba TOK ; Ayşegül Ulu KILIÇ ; Leylagül KAYNAR ; Recep Civan YÜKSEL
Infection and Chemotherapy 2020;52(4):530-538
Background:
Fungal pneumonia is a common infectious complication of hematological cancer (HC) patients. In this retrospective study, the objective was set to identify the risk factors and outcome of fungal pneumonia in adult HC patients.
Materials and Methods:
This retrospective study was conducted with adult (>16 years) HC patients from January 2017 and December 2018.
Results:
During the study period, of 181 patients included 76 were diagnosed with fungal pneumonia. The most common HC was identified as acute myeloid leukaemia (40%). Of the participating patients, 52 (29%) were hematopoietic stem cell transplant (HSCT) recipients.The median age of patients with fungal pneumonia was significantly greater: 57 vs. 48 (odds ratio [OR]: 1.08) and they had longer hospitalization durations (OR: 1.14). Overall, 37 patients (20%) died, and 28-day mortality was significantly greater among patients with fungal pneumonia than without fungal pneumonia (33% vs. 11%). The most significant risk factors for mortality in fungal pneumonia were identified as need of intensive care unit (ICU) (OR: 191.2, P <0.001) and the need of vasopressor support (OR:81.6, P <0.012). ICU-mortality was (88%).
Conclusion
Fungal pneumonia is a lethal complication in HC patients. Intensive care need is the most important predictive factor for mortality.
3.The Outcome of Fungal Pneumonia with Hematological Cancer
Esma EREN ; Emine ALP ; Fatma CEVAHIR ; Tuğba TOK ; Ayşegül Ulu KILIÇ ; Leylagül KAYNAR ; Recep Civan YÜKSEL
Infection and Chemotherapy 2020;52(4):530-538
Background:
Fungal pneumonia is a common infectious complication of hematological cancer (HC) patients. In this retrospective study, the objective was set to identify the risk factors and outcome of fungal pneumonia in adult HC patients.
Materials and Methods:
This retrospective study was conducted with adult (>16 years) HC patients from January 2017 and December 2018.
Results:
During the study period, of 181 patients included 76 were diagnosed with fungal pneumonia. The most common HC was identified as acute myeloid leukaemia (40%). Of the participating patients, 52 (29%) were hematopoietic stem cell transplant (HSCT) recipients.The median age of patients with fungal pneumonia was significantly greater: 57 vs. 48 (odds ratio [OR]: 1.08) and they had longer hospitalization durations (OR: 1.14). Overall, 37 patients (20%) died, and 28-day mortality was significantly greater among patients with fungal pneumonia than without fungal pneumonia (33% vs. 11%). The most significant risk factors for mortality in fungal pneumonia were identified as need of intensive care unit (ICU) (OR: 191.2, P <0.001) and the need of vasopressor support (OR:81.6, P <0.012). ICU-mortality was (88%).
Conclusion
Fungal pneumonia is a lethal complication in HC patients. Intensive care need is the most important predictive factor for mortality.