Background Management of Scedosporium/Lomentospora prolificans infections remain challenging. We described predisposing factors, clinical manifestations and outcomes of these rare mould infections, including predictors of early (1-month) and late (18-month) all-cause mortality and treatment failure. Methods We conducted a retrospective Australian-based observational study of proven/probable Scedosporium/Lomentospora prolificans infections from 2005 to 2021. Data on patient co-morbidities, predisposing factors, clinical manifestations, treatment and outcomes up to 18 months were collected. Treatment responses and death causality were adjudicated. Subgroup analyses, multivariable Cox and logistic regressions were performed. Results Of 61 infection episodes, 37 (60.7%) were attributable to Lomentospora prolificans. Forty-five (73.8%) were proven invasive fungal infections (IFD) and 29/61 (47.5%) were disseminated. Prolonged neutropenia and receipt of immunosuppressant agents were documented in 27/61 (44.3%) and 49/61 (80.3%) episodes, respectively. Voriconazole/terbinafine were administered in 30/31 (96.8%) Lomentospora prolificans infections and voriconazole alone was prescribed for 15/24 (62.5%) Scedosporium spp. infections. Adjunctive surgery was performed in 27/61 (44.3%) episodes. Median time to death post-IFD diagnosis was 9.0 days, and only 23/61 (37.7%) attained treatment success at 18 months. Those who survived beyond 28 days of antifungal therapy were less immunosuppressed with fewer disseminated infections (both p < 0.001). Disseminated infection and haematopoietic stem-cell transplant were associated with increased early and late mortality rates. Adjunctive surgery was associated with lower early and late mortality rates by 84.0% and 72.0%, respectively, and decreased odds of 1-month treatment failure by 87.0%. Conclusions Outcomes associated with Scedosporium/Lomentospora prolificans infections is poor, particularly with Lomentospora prolificans infections or in the highly immunosuppressed population.

No abstract

Background Clostridioides difficile infection (CDI) is associated with significant morbidity and mortality in both healthcare and community settings. Burden and characteristics of disease are not well defined in Australia. We aimed to define the predisposing factors, risks for severe disease and mortality determinants of CDI in Eastern Australia over a 1-year period. Methods This is an observational retrospective study of CDI in hospitalised patients ≥18 years of age in six tertiary institutions from 1 January 2016 to 31 December 2016. Patients were identified through laboratory databases and medical records of participating institutions. Clinical, imaging and laboratory data was input into an electronic database hosted at a central site. Diagnosis, severity, setting of onset, and recurrence for CDI were defined. Results A total of 578 patients (578 CDI episodes) were included. Median age was 65 years (range, 18 to 99 years) and 48.2% were male. Hospital-onset of CDI occurred in 64.0%. Recent antimicrobial use (41.9%) and proton pump inhibitor use (35.8%) was common. Significant risk factors for severe CDI were age <65 years (P < 0.001), malignancy within the last 5 years (P < 0.001), and surgery within the previous 30 days (P < 0.001). Significant risk factors for first recurrence included severe CDI (P = 0.03) and inflammatory bowel disease (P = 0.04). Metronidazole was the most common regimen for first episodes of CDI with 65.2% being concordant with Australian treatment guidelines overall. Determinants for death at 60 days included age over 65 years (P = 0.01), severe CDI (P < 0.001), and antibiotic use within the prior 30 days (P = 0.02). Of those who received metronidazole as first-line therapy, 10.1% died in the 60-day follow-up period, compared to 9.8% of those who received vancomycin (P = 0.86). Conclusion The burden of CDI is large in Australia and continues to complicate healthcare delivery. Patients who experience CDI are vulnerable and require early diagnosis, clinical surveillance, and effective therapy to prevent complications and improve outcomes.