Breakthrough invasive fungal infection among patients with haematologic malignancies : A national, prospective, and multicentre study
Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved..
OBJECTIVES: We describe the current epidemiology, causes, and outcomes of breakthrough invasive fungal infections (BtIFI) in patients with haematologic malignancies.
METHODS: BtIFI in patients with ≥ 7 days of prior antifungals were prospectively diagnosed (36 months across 13 Spanish hospitals) according to revised EORTC/MSG definitions.
RESULTS: 121 episodes of BtIFI were documented, of which 41 (33.9%) were proven; 53 (43.8%), probable; and 27 (22.3%), possible. The most frequent prior antifungals included posaconazole (32.2%), echinocandins (28.9%) and fluconazole (24.8%)-mainly for primary prophylaxis (81%). The most common haematologic malignancy was acute leukaemia (64.5%), and 59 (48.8%) patients had undergone a hematopoietic stem-cell transplantation. Invasive aspergillosis, principally caused by non-fumigatus Aspergillus, was the most frequent BtIFI with 55 (45.5%) episodes recorded, followed by candidemia (23, 19%), mucormycosis (7, 5.8%), other moulds (6, 5%) and other yeasts (5, 4.1%). Azole resistance/non-susceptibility was commonly found. Prior antifungal therapy widely determined BtIFI epidemiology. The most common cause of BtIFI in proven and probable cases was the lack of activity of the prior antifungal (63, 67.0%). At diagnosis, antifungal therapy was mostly changed (90.9%), mainly to liposomal amphotericin-B (48.8%). Overall, 100-day mortality was 47.1%; BtIFI was either the cause or an essential contributing factor to death in 61.4% of cases.
CONCLUSIONS: BtIFI are mainly caused by non-fumigatus Aspergillus, non-albicans Candida, Mucorales and other rare species of mould and yeast. Prior antifungals determine the epidemiology of BtIFI. The exceedingly high mortality due to BtIFI warrants an aggressive diagnostic approach and early initiation of broad-spectrum antifungals different than those previously used.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:87 |
|---|---|
| Enthalten in: |
The Journal of infection - 87(2023), 1 vom: 01. Juli, Seite 46-53 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Puerta-Alcalde, Pedro [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Antifungal |
|---|
| Anmerkungen: |
Date Completed 12.06.2023 Date Revised 21.02.2024 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.jinf.2023.05.005 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM357043995 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM357043995 | ||
| 003 | DE-627 | ||
| 005 | 20240222091256.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.jinf.2023.05.005 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1301.xml |
| 035 | |a (DE-627)NLM357043995 | ||
| 035 | |a (NLM)37201859 | ||
| 035 | |a (PII)S0163-4453(23)00263-3 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Puerta-Alcalde, Pedro |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Breakthrough invasive fungal infection among patients with haematologic malignancies |b A national, prospective, and multicentre study |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 12.06.2023 | ||
| 500 | |a Date Revised 21.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved. | ||
| 520 | |a OBJECTIVES: We describe the current epidemiology, causes, and outcomes of breakthrough invasive fungal infections (BtIFI) in patients with haematologic malignancies | ||
| 520 | |a METHODS: BtIFI in patients with ≥ 7 days of prior antifungals were prospectively diagnosed (36 months across 13 Spanish hospitals) according to revised EORTC/MSG definitions | ||
| 520 | |a RESULTS: 121 episodes of BtIFI were documented, of which 41 (33.9%) were proven; 53 (43.8%), probable; and 27 (22.3%), possible. The most frequent prior antifungals included posaconazole (32.2%), echinocandins (28.9%) and fluconazole (24.8%)-mainly for primary prophylaxis (81%). The most common haematologic malignancy was acute leukaemia (64.5%), and 59 (48.8%) patients had undergone a hematopoietic stem-cell transplantation. Invasive aspergillosis, principally caused by non-fumigatus Aspergillus, was the most frequent BtIFI with 55 (45.5%) episodes recorded, followed by candidemia (23, 19%), mucormycosis (7, 5.8%), other moulds (6, 5%) and other yeasts (5, 4.1%). Azole resistance/non-susceptibility was commonly found. Prior antifungal therapy widely determined BtIFI epidemiology. The most common cause of BtIFI in proven and probable cases was the lack of activity of the prior antifungal (63, 67.0%). At diagnosis, antifungal therapy was mostly changed (90.9%), mainly to liposomal amphotericin-B (48.8%). Overall, 100-day mortality was 47.1%; BtIFI was either the cause or an essential contributing factor to death in 61.4% of cases | ||
| 520 | |a CONCLUSIONS: BtIFI are mainly caused by non-fumigatus Aspergillus, non-albicans Candida, Mucorales and other rare species of mould and yeast. Prior antifungals determine the epidemiology of BtIFI. The exceedingly high mortality due to BtIFI warrants an aggressive diagnostic approach and early initiation of broad-spectrum antifungals different than those previously used | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Antifungal | |
| 650 | 4 | |a Breakthrough | |
| 650 | 4 | |a Fungal disease | |
| 650 | 4 | |a Invasive fungal infection | |
| 650 | 4 | |a Mortality | |
| 650 | 7 | |a Antifungal Agents |2 NLM | |
| 700 | 1 | |a Monzó-Gallo, Patricia |e verfasserin |4 aut | |
| 700 | 1 | |a Aguilar-Guisado, Manuela |e verfasserin |4 aut | |
| 700 | 1 | |a Ramos, Juan Carlos |e verfasserin |4 aut | |
| 700 | 1 | |a Laporte-Amargós, Júlia |e verfasserin |4 aut | |
| 700 | 1 | |a Machado, Marina |e verfasserin |4 aut | |
| 700 | 1 | |a Martin-Davila, Pilar |e verfasserin |4 aut | |
| 700 | 1 | |a Franch-Sarto, Mireia |e verfasserin |4 aut | |
| 700 | 1 | |a Sánchez-Romero, Isabel |e verfasserin |4 aut | |
| 700 | 1 | |a Badiola, Jon |e verfasserin |4 aut | |
| 700 | 1 | |a Gómez, Lucia |e verfasserin |4 aut | |
| 700 | 1 | |a Ruiz-Camps, Isabel |e verfasserin |4 aut | |
| 700 | 1 | |a Yáñez, Lucrecia |e verfasserin |4 aut | |
| 700 | 1 | |a Vázquez, Lourdes |e verfasserin |4 aut | |
| 700 | 1 | |a Chumbita, Mariana |e verfasserin |4 aut | |
| 700 | 1 | |a Marco, Francesc |e verfasserin |4 aut | |
| 700 | 1 | |a Soriano, Alex |e verfasserin |4 aut | |
| 700 | 1 | |a González, Pedro |e verfasserin |4 aut | |
| 700 | 1 | |a Fernández-Cruz, Ana |e verfasserin |4 aut | |
| 700 | 1 | |a Batlle, Montserrat |e verfasserin |4 aut | |
| 700 | 1 | |a Fortún, Jesús |e verfasserin |4 aut | |
| 700 | 1 | |a Guinea, Jesús |e verfasserin |4 aut | |
| 700 | 1 | |a Gudiol, Carlota |e verfasserin |4 aut | |
| 700 | 1 | |a García, Julio |e verfasserin |4 aut | |
| 700 | 1 | |a Ruiz Pérez de Pipaón, Maite |e verfasserin |4 aut | |
| 700 | 1 | |a Alastruey-Izquierdo, Ana |e verfasserin |4 aut | |
| 700 | 1 | |a Garcia-Vidal, Carolina |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t The Journal of infection |d 1982 |g 87(2023), 1 vom: 01. Juli, Seite 46-53 |w (DE-627)NLM012791822 |x 1532-2742 |7 nnns |
| 773 | 1 | 8 | |g volume:87 |g year:2023 |g number:1 |g day:01 |g month:07 |g pages:46-53 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.jinf.2023.05.005 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 87 |j 2023 |e 1 |b 01 |c 07 |h 46-53 | ||