Retrospective Evaluation of Risk Factors for the Development of Invasive Fungal Infections in Immunosuppressed Patients

Objective: The incidence of invasive fungal infection (IFI) is increasing in immunosuppressed patients. Thus, this study aimed to compare the types and the distribution of IFI, determine the probable risk factors in its development, and assess the mortality and underlying diseases among patients with hematological malignancies and those with non-hematological immunosuppression. Methods: This retrospective study included 84 adult patients with IFI diagnosis between January 1, 2012, and April 1, 2014, at our hospital. Results: The distribution of cases was documented as follows: 58 (69.0%) patients were proven with IFI, 12 (14.3%) with probable IFI, and 14 (16.7%) with possible IFI. Patient distributions with proven IFI were as follows: 91.4% (53/58) with invasive candidiasis (IC), 5.2% (3/58) with invasive pulmonary aspergillosis (IPA), 1.7% (1/58) with nasopharyngeal invasive fungal involvement, and 1.7% (1/58) with invasive fungal involvement in the colon. All cases of probable and possible IFE (26/26, 100%) were determined as IPA. The following is previously known risk factors for IFI development were evaluated for both groups: immunosuppressive drug usage, renal replacement therapy requirement, mechanical ventilation requirement, presence of a central venous catheter, presence of a urinary catheter, presence of gastrointestinal catheter, mucositis/diarrhea/ileus history, malnutrition, blood product transfusion, bacterial infection, antibacterial treatment, length of hospital and intensive care unit stay, and duration of neutropenia. The immunosuppressive drug usage and neutropenia duration were found to be statistically significant between the hematologic malignancy and non-hematologic immunosuppressive groups. No significant difference was found in other parameters (p<0.05). Conclusion: Our findings followed the literature; however, the mortality in the IC group was found high, similar to the IPA group. Additionally, this study revealed that IFI epidemiology may vary based on the region and the patient. IFIs, which are increasing in frequency, need to be evaluated with a good knowledge of risk factors, using newly developed diagnostic methods, with a multidisciplinary approach.