Hong H, et al. Infect Chemother. 2024 Sep;56:e44. https://doi.org/10.3947/ic.2024.0046

Invasive yeast infections (IYIs) remain a significant cause of morbidity and mortality in patients with hematologic diseases. We retrospectively analyzed 193 IYI episodes among 179 patients admitted to a tertiary hematology hospital (2012–2023). Candida species accounted for 91.7% (n = 177), while non-Candida yeasts comprised 8.3% (n = 16). Among invasive candidiasis, non-albicans Candida spp. were predominant, representing 76.8% (136/177), with C. tropicalis (36.2%, 64/177) being the most frequently isolated species. Among non-Candida yeasts, Cryptococcus neoformans (n = 10) was the most commonly identified pathogen. The incidence and 42-day mortality rate of IYIs were 0.199 and 0.095 per 1000 patient-days, respectively. The 42-day case-fatality rate remained high at 47.7%. In categorical analysis, age >65 years, corticosteroid use, elevated lactate (>2 mmol/L), neutropenia (<500/mm³), vasopressor use, and mechanical ventilation were more common in non-survivors. Primary bloodstream infections were more frequent in non-survivors, whereas catheter-related and abdominal-origin infections were predominant among survivors. Concomitant bacteremia was observed in 32.6% of IYI cases (n = 63), with Enterococcus faecium being the most frequently isolated co-pathogen. Our findings illustrate the evolving epidemiology of IYIs in hematologic patients, marked by the emergence of C. tropicalis as the predominant species, sustained mortality, and frequent bacterial co-infections, collectively reflecting the substantial clinical burden of IYIs.

Background: Letermovir prophylaxis prevents early clinically significant cytomegalovirus (CMV) infection (CS-CMVi) after allogeneic hematopoietic cell transplantation (allo-HCT), but late CS-CMVi after discontinuation at Day 100 remains a clinical challenge. This study evaluated whether the dynamics of CMV-specific cell-mediated immunity (CMI) are associated with subsequent late CS-CMVi.,Methods: In 40 CMV-seropositive adult allo-HCT recipients receiving letermovir, pp65-, immediate-early (IE)-1-, and IE-2-specific T-cell responses were serially quantified by enzyme-linked immunospot (ELISPOT) assay up to 6 months post-transplantation. CMI trajectories were analyzed using linear mixed models (LMM). Month 3 CMI, measured before letermovir discontinuation, was evaluated using receiver operating characteristic (ROC) curves, landmark Kaplan-Meier analysis, and Cox regression.,Results: Late CS-CMVi occurred in 28.2% (11/39) of at-risk patients by Day 210. LMM revealed blunted recovery of IE-2- and IE-1-specific CMI in these patients (group × time interaction, P = 0.003 and P = 0.022), whereas pp65 trajectories did not differ (P = 0.381). At Month 3 (n = 32), discriminative ability was modest (area under the ROC curve, 0.59–0.63). Exploratory cut-offs (<56 spots for pp65 and <4 for IE-2) were associated with lower late CS-CMVi-free survival (log-rank P = 0.030 and P = 0.029), but these associations were attenuated in leave-one-out cross-validation, and continuous Month 3 CMI levels were not significantly associated with late CS-CMVi.,Conclusions: Impaired recovery of IE-specific CMI around the time of letermovir discontinuation is associated with subsequent late CS-CMVi. A single Month 3 measurement showed limited predictive performance, and the proposed thresholds require validation in larger prospective cohorts.