404. Trends in epidemiology and sites of involvement by invasive fungal infections in patients with hematological malignancies: a 20-year autopsy study
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Despite improvements in fungal diagnostics, autopsy series remain the gold standard to study the epidemiology of invasive fungal infections (IFIs).
Methods: We analyzed trends in clinical, microbiological characteristics and sites of involvement by autopsy-proven IFIs in patients with hematological malignancies over a 20 year study period (01/1989-08/2008) in our institution.
Results: IFIs were identified in 352 of 1213 (29%) autopsy examinations. The prevalence of IFIs decreased significantly (P =0.01) during the last 5 years of the study. Most of the IFIs (269/ 352 [76%]) occurred in patients with leukemia, predominantly those with acute myelogenous leukemia (144 [40%].The prevalence of severe neutropenia at death decreased while the percentage of patients with IFIs who had received a significant dose of corticosteroids increased significantly during the years of the study. Active hematologic disease was found at autopsy in 77%. Most IFIs (253/352, 72%) were not diagnosed antemortem. Invasive mold infections (IMIs) were the predominant IFIs (70%); 53% of IMIs were disseminated and accounted for a significant proportion of cases of hepatic (66%), splenic (52%), gastrointestinal (55%), and renal (56%) involvement by IFIs. Aspergillosis was the most common IMI (79%), causing most cases of IFIs with central nervous system (66%), pulmonary (57%) and heart involvement (59%). All but Mucorales prevalence (which remained stable) declined during the last 5 years of the study. Invasive candidiasis was present in 10% of autopsies. Following the introduction of fluconazole prophylaxis (1991) there was a significant decline in the prevalence of hepatosplenic, renal and gastrointestinal tract involvement by Candida spp. There was a continuous decline in the autopsy rate over the years of the study.
Conclusions: The declining autopsy rate poses a challenge in studying the evolving epidemiology of IFIs. The frequent dissemination of IMIs at autopsy necessitates intense pre-emptive therapeutic strategies with broad spectrum antifungal agents that have a wide tissue distribution.
Georgios Chamilos, MD1, Dimitrios Kontoyiannis, MD, ScD, FIDSA1, Konstantino Leventakos, MD1, Russell Lewis, PharmD2, Mario Luna, MD3, Issam Raad, MD, Pheroze Tamboli, MD1 and  K. Leventakos, None. 
R. E. Lewis,
Merck & Co., Inc. Role(s): Grant Investigator, Scientific Advisor (Review Panel or Advisory Committee), Speaker's Bureau, Received: Research Grant, Speaker Honorarium, Consulting Fee.
Astellas Role(s): Research Relationship, Scientific Advisor (Review Panel or Advisory Committee), Received: Research Grant, Speaker Honorarium.
Enzon Role(s): Research Relationship, Received: Research Support.
G. Chamilos, None..
P. Tamboli, None. 
I. I. Raad,
Cook, Inc. Role(s): Consultant, Research Relationship, Other, Royalties related to technology on which Dr. Raad is an inventor/co-inventor, Consultant, Research Relationship, Other, Royalties related to technology on which Dr. Raad is an inventor/co-inventor, Consultant, Research Relationship, Other, Royalties related to technology on which Dr. Raad is an inventor/co-inventor, Received: Educational Grant, Licensing Agreement or Royalty, Consulting Fee.
M. Luna, None. 
D. P. Kontoyiannis,
Merck & Co., Inc. Role(s): Research Relationship, Scientific Advisor (Review Panel or Advisory Committee), Speaker's Bureau, Received: Research Grant, Speaker Honorarium.
Pfizer Role(s): Speaker's Bureau, Received: Speaker Honorarium.
Astellas Role(s): Research Relationship, Received: Research Grant., (1)The University of Texas M.D. Anderson Cancer Center, Houston, TX, (2)Clinical Sciences and Administration, University of Houston College of Pharmacy, Houston, TX, (3)MD Anderson Cancer Center

Disclosures:

G. Chamilos, None

D. Kontoyiannis, None

K. Leventakos, None

R. Lewis, None

M. Luna, None

I. Raad, None

P. Tamboli, None