Characteristics and Risk Factors for Mortality of Invasive Non-Aspergillus Mould Infections in Patients with Haematologic diseases: A Single-Centre 7-Year Cohort Study.

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Characteristics and Risk Factors for Mortality of Invasive Non-Aspergillus Mould Infections in Patients with Haematologic diseases: A Single-Centre 7-Year Cohort Study.

Mycoses. 2019 Nov 24;:

Authors: Lee HJ, Cho SY, Lee DG, Park C, Chun HS, Park YJ

Abstract
BACKGROUND: Since mould-active azole prophylaxis has become a standard approach for patients with high-risk haematologic diseases, the epidemiology of invasive fungal infections (IFIs) has shifted toward non-Aspergillus moulds.
OBJECTIVES: It was aimed to identify the epidemiology and characteristics of non-Aspergillus invasive mould infections (NAIMIs).
METHODS: Proven/probable NAIMIs developed in patients with haematologic diseases were reviewed from January 2011 to August 2018 at Catholic Hematology hospital, Seoul, Korea.
RESULTS: There were 689 patients with proven/probable invasive mould infections; of them, 46 (47 isolates) were diagnosed with NAIMIs. Fungi of the mucorales order (n = 27, 57.4%) was the most common causative fungi, followed by Fusarium (n = 9, 19.1%). Thirty-four patients (73.9%) had neutropenia upon diagnosis of NAIMIs, and 13 (28.3%) were allogeneic stem cell transplantation recipients. The most common site of NAIMIs were the lung (n = 27, 58.7%), followed by disseminated infections (n = 8, 17.4%). There were 23.9% (n = 11) breakthrough IFIs, and 73.9% (n = 34) had coexisting bacterial or viral infections. The overall mortality at 6 and 12 weeks was 30.4% and 39.1%, respectively. Breakthrough IFIs (adjusted hazards ratio [aHR] = 1.99, 95% CI: 1.3-4.41, P = 0.031) and surgical treatment (aHR = 0.09, 95% CI: 0.02-0.45, P = 0.003) were independently associated with 6-week overall mortality.
CONCLUSIONS: NAIMIs were not rare, and occur as a complex form of infection often accompanied by breakthrough/mixed/concurrent IFIs and bacterial or viral infections. More active diagnostic efforts for NAIMIs are needed.

PMID: 31762083 [PubMed – as supplied by publisher]

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