[Invasive Mold Infections in Patients with Hematologic Malignities: The Effects of Environmental Factors]. / Hematolojik Maligniteli Hastalarda Invaziv Küf Enfeksiyonlari: Çevresel Faktörlerin Etkisi.

Invasive fungal infections (IFI) continue to be an important cause of morbidity and mortality in patients with hematological malignancies. Candida and Aspergillus species constitute most of the IFI in these patients.. It has been reported that most of the invasive aspergillosis epidemics are related to the construction works in the hospital. In this study, we aimed to investigate the frequency of IFI in the old and the new hospital building after relocation in patients with hematological malignancies. Of 8042 patients who were hospitalized in the Department of Hematology, Ondokuz Mayis University Faculty of Medicine between January 2015 and September 2019, 412 patients who were initiated antifungal therapy were included in the study. The patients in the hematology clinic, which were moved to the new oncology hospital building in January 2018, were grouped as prior and after relocation, and their demographical data, hematological diagnosis, chemotherapy regimens, mortality, IFI, focus of infection, presence of central venous catheter, antifungal prophylaxis and treatment, galactomannan level, fungal culture and computed tomography (CT) findings were evaluated retrospectively. It was determined that 55% of the patients were male and the median age was 58 (range:18-93). The rate of IFI development was 5.12% (n= 412) and the rate of invasive mold infection was 1.2% (n= 145). The most common hematological disease for which antifungal treatment initiated was acute myeloid leukemia (AML) with a rate of 50% (n= 206/412). Of patients, 73% received induction chemotherapy (42%, first induction, 31% reinduction), 13.4% received consolidation therapy. Invasive mold infection was diagnosed as 40% possible, 59% probable, 1% proven. While patients had similar characteristics such as age, gender, hematological disease, chemotherapy regimens and antifungal prophylaxis prior and after transportation, the rate of development of invasive mold infection was 2.1%, 2.06 / 1000 patient days, before transportation, 1.37% (p= 0.009), 1.15/1000 patient days (p<0.001) after transportation, and it was statistically significantly lower after transportation. The median value of galactomannan antigen was detected as 0.17 (0.02-5.9). Blood cultures revealed 10.3% fungal growth and the most common growth was Candida albicans with 54.8% and Mucor spp. as mold with 3.2%. Large-scale construction works such as renovation, extension and demolition works in old hospital buildings are a permanent condition in different units. Clinicians should be aware of that infections due to opportunistic fungi can be seen in immunosuppressive patients close to such construction sites, and even cause epidemics. It should be kept in mind that these infections, which can progress with serious morbidity and mortality are difficult to treat but can be prevented by infection control measures.

Age is not a risk factor in survival of severely ill patients with co-morbidities in a medical intensive care unit.

BACKGROUND: The individuals over 65 years old constitute an important patient population of medical intensive care units (ICUs). AIM: To evaluate the risk factors for mortality in a medical ICU consisting a group of patients with a large number of co-morbidities. METHODS: This is a retrospective study involving patients who were followed for more than 48 h. The cohort was divided into two groups according to age: (1) young, < 65 years old, and (2) elderly, ≥ 65 years old. RESULTS: A total of 693 patients (303 F, 390 M) were included. The median age was 68 years (18-97). There were 279 (40.3%) young and 414 (59.7%) elderly patients. There was no difference between the groups in gender and mortality (p = 0.436, p = 0.932, respectively). Most of the co-morbid diseases were more common in the elderly except solid malignancies which were more common in young patients (p = 0.033). Long ICU stay, long hospital stay before ICU, high APACHE II and Charlson co-morbidity index scores, pneumonia, acute hepatic failure/coma, malignancy, acute hemodialysis, need for vasopressors, and invasive mechanical ventilation were independent predictors of ICU mortality. CONCLUSION: Age and gender were not found to be predictors of mortality. There was no survival advantage between young and elderly patients. Co-morbid diseases, apart from malignancy, had no effect on mortality. In developing countries, where patients with terminal illness and multiple co-morbid diseases are treated in the ICU, age should not be a determining factor in patient selection for ICU or in the treatment decisions to be applied to patients.