Data Collection
The potential case list obtained from HIM was first reviewed to remove
duplicate cases, confirm cancer diagnosis inclusion criteria (ALL, AML,
or lymphoma), and exclude any patients with underlying immunodeficiency
or who developed IMI after HSCT or organ transplant. For the remaining
patients, demographic, laboratory, clinical and radiographic data were
manually abstracted from the electronic medical record system using a
standardized, comprehensive data abstraction form. Demographic and
clinical characteristics of the total number of cases diagnosed during
the study time period were obtained from records maintained by the
clinical disease-based teams and verified in the medical record.
All remaining potential IMI cases were then classified as meeting or not
meeting criteria for probable or proven IMI, as defined by the 2008
European Organization for Research and Treatment of Cancer/Mycoses Study
Group (EORTC/MSG) Consensus
Group.9 To make this
determination, records were reviewed by two independent members of the
research team (AD, JB, KR, PH, AM, AI, MC), and discordant entries were
resolved through group discussion. All mold isolates noted in the
medical record were identified according to standard laboratory
practices. The date of diagnosis of IMI was defined as the date of first
positive culture and/or diagnostic study. Clinical information regarding
the underlying disease status (date of cancer diagnosis, type of cancer,
and whether the patient was receiving upfront treatment or treatment for
relapsed disease), relevant exposures concurrent to the diagnosis of
IMI, and relevant host factors were abstracted for all patients. Factors
previously established as risk factors for IMI were noted if present
within 2 weeks of the IMI diagnosis, such as neutropenia (at least one
incidence of absolute neutrophil count <500
cells/mm3), hyperglycemia (at least one incidence of
random blood glucose level >200 mg/dl), intensive care unit
admission, and concomitant bacterial infection(s) requiring antibiotics.