Trends in the postmortem epidemiology of invasive fungal infections at a university hospital

Abstract

Background: Due to the continuing lack of sensitive and specific diagnostic tools, clinical data on opportunistic invasive fungal infections (IFIs) remain difficult to assess and postmortem data are indispensable to monitor trends in frequency and disease patterns.

Methods: Following-up on our previous report covering the period between 1978 and 1992, all protocols of postmortems performed between 1993 and 2005 at the University Hospital of Frankfurt/Main were retrospectively screened for the presence of IFIs.

Results: The analysis of 2707 consecutive autopsies identified 221 patients with IFIs (mean age, 52 years; range, 10 days-94 years). The prevalence of IFIs at autopsy steadily increased over the analyzed time periods (from 6.6% in 1993-1996 to 10.4% in 2001-2005), continuing the trend that was observed at our institution before. The increasing prevalence of IFIs was mainly due to an increase in Candida infections; rates of infections caused by Aspergillus, Cryptococcus, Zygomycetes and Pneumocystis remained constant. However, Aspergillus remained the leading pathogen. Patients with hematologic malignancies had the highest frequency of IFIs at postmortem. Candida most commonly affected the gastrointestinal tract, whereas Aspergillus most commonly affected the lung.

Conclusions: The results of this analysis show continuing and relevant changes in the epidemiology of IFIs over time. Despite the expanding antifungal armamentarium, IFIs infections remain an important cause of morbidity and mortality in severely ill hospitalized patients.