Prevalence, Risk Factors, and Outcome of Invasive Fungal Infections in Hematopoietic Stem Cell Transplant Recipients: A Prospective Cross-Sectional Study From Iran Publisher



Keyhanian N ; Salehi M ; Manshadi SAD ; Mousavi SA ; Vaezi M ; Meidani M ; Solduzian M ; Shahrabi M ; Ahmadikia K ; Shiraji ST ; Akova M ; Maertenes J ; Alijani N
Source: Current Medical Mycology Published:2026

Abstract

Background and Purpose: Invasive fungal infections (IFIs) are the second leading cause of infection in hematopoietic stem cell transplant (HSCT) recipients. Although Knowledge of the local epidemiology of breakthrough IFIs should be considered in terms of guiding organizational effective antifungal prophylaxis strategy, however, institutional approach for ongoing surveillance of the rates and epidemiology of IFIs in high-risk patients like HSCT has been less appreciated. Therefore, this study was aimed at investigating the prevalence, risk factors, and outcome of IFIs in HSCT patients. Materials and Methods: A prospective study was carried out between March 2021 and March 2022 in HSCT wards of an educational – medical hospital of Tehran University of Medical Sciences to rate the incidence of IFIs. All HSCT recipients were enrolled except those who had incomplete files, had a history of previous corticosteroids receipt for rheumatologic or immunologic disorders, or did not consent. Upon suspicion of IFIs, the appropriate sample was collected for mycological assay. Those with proven/ probable IFIs according to the consensus criteria defined by EORTC/MSG were only counted for evaluation of the prevalence, risk factor and outcome of the IFIs. Results: A total of 330 HSCT recipients were enrolled. The Prevalence of IFIs was 9.6 %, with aspergillosis as the most frequent one being observed in 97 % of the cases. Pulmonary involvement was the most frequent clinical presentation (78.1 %). Most of IFIs were developed before engraftment (90.6%). CMV infection and acute myeloid leukemia (AML) significantly raised the odds ratio of IFIs development (odds ratios of 1.07 and 12.6; p-values of 0.002 and < 0.001, respectively). The mortality rate was 12.5 %. CMV infection, lower age and HLA-mismatch related donor were factors significantly associated with fatality of IFIs (odds ratios of 15.5, 1.07 and 10.70; p-values of 0.005, 0.002 and 0.016 respectively). Conclusion: IFIs were found to be relatively common complication of allogenic HSCT and continue to be associated with poor prognosis. CMV infection can be independently associated with IFIs and unfavorable outcomes, while HSCT HLA mismatch donors increase the risk of unfavorable outcomes. As a result, tailoring antifungal prophylaxis in these groups of high-risk hosts is crucial. Copyright© 2025, Published by Mazandaran University of Medical Sciences on behalf of Iranian Society of Medical Mycology and Invasive Fungi Research Center.