To investigate the incidence, risk factors, and outcome of Aspergillus infections among marrow transplant recipients, records from 2496 patients were reviewed, and 214 patients had Aspergillus organisms identified. Of these, 158 had invasive aspergillosis, 44 were colonized, and 12 had contaminated cultures. The incidence of invasive aspergillosis increased from 5.7% to 11.2% during the study. The onset of infection was bimodal, peaking 16 and 96 days after transplant. For patients within 40 days after transplant, underlying disease, donor type, season, and transplant outside of laminar air flow rooms were associated with significant risk for invasive aspergillosis. For patients >40 days after transplant, age, underlying disease, donor type, graft-versus-host disease, neutropenia, and corticosteroid use were associated with increased risk of aspergillosis. Only 31% of infected patients were neutropenic at the time of diagnosis. The risk factors for aspergillosis depend on the time after marrow transplant and include both host and environmental characteristics.
Bibliographical noteFunding Information:
Received 11 September 1996; revised 8 January 1997. Presented in part: 34th Interscience Conference on Antimicrobial Agents and Chemotherapy, Orlando, Florida, 4–7 October 1994. Financial support: NIH (CA-18029, HL-36444). A.W. is a recipient of the 1994–1996 American Social Health Association Postdoctoral Research Fellowship in Sexually Transmitted Diseases. Reprints: Dr. Raleigh A. Bowden, Fred Hutchinson Cancer Research Center, Program in Infectious Diseases, 1124 Columbia St., M 115, Seattle, WA 98104. Correspondence: Dr. Anna Wald, University of Washington, Virology Research Clinic, 1001 Broadway, Suite 320, Seattle, WA 98122.