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<p>Fungal infections are common and serious complications in patients undergoing bone marrow transplantation (BMT). Despite the use of prophylactic antifungal therapy, breakthrough infections can occur and lead to significant morbidity and mortality. In this retrospective observational study, we attempted to understand the clinico-epidemiological patterns of breakthrough invasive fungal infections (bIFI) in BMT patients of a tertiary cancer care hospital of eastern India. Cases were included between 2011 and 2021. European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC MSG 2020) criteria were used for diagnosis of invasive fungal infection, and European Confederation of Medical Mycology (ECMM) definition was used to diagnose bIFI. Incidence of bIFI was found to be 5.1% (<i>n</i> = 29), due to Aspergillus sp. (<i>n</i> = 19, 65.5%), Candida sp. (<i>n</i> = 9, 31%), and Fusarium sp. (<i>n</i> = 1, 3.4%) as the pathogens. Nine (31.03%) and 20 (68.97%) were proven and probable cases, respectively. Mortality was higher in allogeneic transplant (36% vs. 25%, <i>p</i> = 0.08), and GVHD was significantly more in bIFI cases. Increased case detection was noted after starting diagnostic-driven antifungal usage with worsened air quality. Most of the cases occurred on Amphotericin B use (<i>p</i> = 0.1), while all-cause mortality of patients on Posaconazole (21.83%) was significantly higher (<i>p</i> &lt; 0.0001). The incidence of bIFI in our study was lower than the available Indian and global data, with highest incidence seen with amphotericin B use and Aspergillus being the most common organism responsible.</p>

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Breakthrough Fungal Infections Amongst Hematopoietic Stem Cell Transplant Recipients: A Retrospective Observational Study From An Indian Tertiary Cancer Facility

  • 期刊论文

  • 发表日期：

    2026年5月20日

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  • Soumyadip Chatterji,
  • Dibakar Poddar,
  • Jeevan Kumar,
  • Shouriyo Ghosh,
  • Arijit Nag,
  • Debranjani Chattopadhyay,
  • Saswata Saha,
  • Rajat Pincha,
  • Reghu KS,
  • Sanjay Bhattacharya,
  • Gaurav Goel,
  • Satyam Mukherjee,
  • Argha Chatterjee,
  • Priya Ghosh,
  • Rizwan Javed,
  • Reena Nair,
  • Mammen Chandy,
  • Parijat Das

摘要

Fungal infections are common and serious complications in patients undergoing bone marrow transplantation (BMT). Despite the use of prophylactic antifungal therapy, breakthrough infections can occur and lead to significant morbidity and mortality. In this retrospective observational study, we attempted to understand the clinico-epidemiological patterns of breakthrough invasive fungal infections (bIFI) in BMT patients of a tertiary cancer care hospital of eastern India. Cases were included between 2011 and 2021. European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC MSG 2020) criteria were used for diagnosis of invasive fungal infection, and European Confederation of Medical Mycology (ECMM) definition was used to diagnose bIFI. Incidence of bIFI was found to be 5.1% (n = 29), due to Aspergillus sp. (n = 19, 65.5%), Candida sp. (n = 9, 31%), and Fusarium sp. (n = 1, 3.4%) as the pathogens. Nine (31.03%) and 20 (68.97%) were proven and probable cases, respectively. Mortality was higher in allogeneic transplant (36% vs. 25%, p = 0.08), and GVHD was significantly more in bIFI cases. Increased case detection was noted after starting diagnostic-driven antifungal usage with worsened air quality. Most of the cases occurred on Amphotericin B use (p = 0.1), while all-cause mortality of patients on Posaconazole (21.83%) was significantly higher (p < 0.0001). The incidence of bIFI in our study was lower than the available Indian and global data, with highest incidence seen with amphotericin B use and Aspergillus being the most common organism responsible.