A cohort study on breakthrough invasive fungal infections in high-risk patients receiving antifungal prophylaxis

Biehl, Lena M; Vehreschild, J. J.; Liss, Blasius; Franke, Bernd; Markiefka, Birgid; Persigehl, Thorsten; Bücker, V; Wisplinghoff, Hilmar; Scheid, Christof; Cornely, Oliver A.; Vehreschild, Maria J. G. T.

doi:10.1093/jac/dkw199

Cited by 55 publications

(42 citation statements)

References 22 publications

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“…Another explanation for high IFI incidence may be the unpredictable or sometimes poor bioavailability of antifungal agents (especially posaconazole) used for prophylaxis. In the literature, observational studies on bIFI have reported incidences of probable/proven bIFI ranging from 3% to 13% (22)(23)(24)(25)(26)(27)(28). The rate of bIFI observed in the group receiving prophylaxis is compatible with the literature.…”

Section: Discussionsupporting

confidence: 83%

Epidemiology and analysis of invasive fungal infections in patients withhematological malignancies: a single-center real-life experience

Soyer¹,

Ünal²,

Vural³

et al. 2017

Turk J Med Sci

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Background/aim: Invasive fungal infection (IFI) causes morbidity and mortality among patients with hematological malignancies. We evaluated the incidence and treatment characteristics of IFIs between October 2012 and December 2013. Materials and methods:Patients who received chemotherapy or stem cell transplantation were retrospectively evaluated. Fungal infections were classified according to EORTC criteria.Results: Prophylaxis and antifungal therapy were given in 30.5% and 23.6% of 522 chemotherapy courses, respectively. The incidence of proven/probable IFI was 6.7%. The incidence of IFI among patients who received prophylaxis was significantly higher than among those who did not receive it (11.3% vs. 4.6%, P = 0.005). There was no significant difference between patients who received mold-active and no mold-active prophylaxis (P = 0.098). The most common single agent therapy and causative pathogen was liposomal amphotericin B (57.1%) and Aspergillus (n = 5), respectively. IFI-attributable mortality rate was 14.2% in 6 weeks. Conclusion:The IFI incidence and mortality rate were similar to that reported in the literature. The IFI rate was higher in the group using prophylaxis, as this is a high-risk group. Although the IFI rate was not significantly different between groups using prophylaxis, patients should be followed closely for the effective use of posaconazole prophylaxis.

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Section: Discussionsupporting

confidence: 83%

Epidemiology and analysis of invasive fungal infections in patients withhematological malignancies: a single-center real-life experience

Soyer¹,

Ünal²,

Vural³

et al. 2017

Turk J Med Sci

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“…Ten patients (21.7%) had mixed IFIs, seven patients (15.2%) had concurrent IFIs and 11 patients had breakthrough IFIs (23.9%). Of these, breakthrough IFI is well‐known risk factor for mortality in remission induction chemotherapy of AML patients and allo‐HSCT recipients . Similarly, multivariate analysis in our study showed that breakthrough IFI is an independent predictor of poor outcome (aHR = 1.99, 95% CI: 1.3‐4.41, P = .031).…”

Section: Discussionsupporting

confidence: 74%

“…These recent advances in the use of PAP during chemotherapy and haematopoietic stem cell transplantation (HSCT) have reduced the number of IFIs and improved the survival of high‐risk patients . However, they have also led to changes in the epidemiology of IFIs, and breakthrough IFIs that developed during treatment with mould‐active azoles have been reported . Thus, concerns on increasing possibility of rare and more resistant mould infections have been raised, and recent reports have described increasing incidence of non‐ Aspergillus invasive mould infections (NAIMIs), often in patients receiving mould‐active azole drugs …”

Section: Introductionmentioning

confidence: 99%

“…4,5 However, they have also led to changes in the epidemiology of IFIs, and breakthrough IFIs that developed during treatment with mould-active azoles have been reported. [6][7][8][9] Thus, concerns on increasing possibility of rare and more resistant mould infections have been raised, 10 and recent reports have described increasing incidence of non-Aspergillus invasive mould infections (NAIMIs), often in patients receiving mould-active azole drugs. [10][11][12] Clinically, it is difficult to distinguish NAIMIs from invasive aspergillosis (IA), and NAIMIs often have a progressive and aggressive course.…”

Section: Introductionmentioning

confidence: 99%

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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

Lee

Cho

Lee

et al. 2019

Mycoses

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Summary 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 towards non‐Aspergillus moulds. It was aimed to identify the epidemiology and characteristics of non‐Aspergillus invasive mould infections (NAIMIs). Proven/probable NAIMIs developed in patients with haematologic diseases were reviewed from January 2011 to August 2018 at Catholic Hematology hospital, Seoul, Korea. 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%) were 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 was 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 co‐existing 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 = .031) and surgical treatment (aHR = 0.09, 95% CI: 0.02‐0.45, P = .003) were independently associated with 6‐week overall mortality. 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.

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“…At first glance it appears obvious to choose a triazole for first‐line treatment, however, most patients at risk will already receive triazole prophylaxis. A switch in antifungal drug class upon presumed breakthrough aspergillosis is plausible, but has not been subject to randomised clinical trials …”

Section: Introductionmentioning

confidence: 99%

EQUAL Aspergillosis Score 2018: An ECMM score derived from current guidelines to measure QUALity of the clinical management of invasive pulmonary aspergillosis

Cornely

Köehler

Arenz

et al. 2018

Mycoses

Self Cite

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Invasive pulmonary aspergillosis is a serious threat to immunocompromised and critical care patients. Recent detailed guidelines and treatment algorithms lead microbiologists and clinicians in diagnosis and treatment of invasive aspergillosis. Currently, there is no tool available that allows to measure guideline adherence. To develop such a tool, we reviewed current guidelines provided by five scientific societies (European Society for Clinical Microbiology and Infectious Diseases, European Confederation of Medical Mycology, European Respiratory Society, Infectious Diseases Society of America (IDSA), and Infectious Diseases Working Party of the German Society for Hematology and Medical Oncology) and selected the strongest recommendations for management as key components for our scoring tool. We integrated diagnostic measures (chest computed tomography, bronchoalveolar lavage with galactomannan, fungal culture, fungal polymerase chain reaction analysis, species identification, susceptibility testing, histology with silver stain, Periodic acid-Schiff staining, and molecular diagnostics), treatment (antifungal choice and therapeutic drug monitoring), and follow-up computed tomography. The EQUAL Aspergillosis Score 2018 aggregates and weighs the components and provides a tool to support antifungal stewardship and to quantify guideline adherence.

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A cohort study on breakthrough invasive fungal infections in high-risk patients receiving antifungal prophylaxis

Abstract: Rates of bIFIs observed in our population were comparable to previous data. There was no clear shift towards rare species, as previously reported. A high variety of treatment approaches was observed.

Cited by 55 publications

References 22 publications

Epidemiology and analysis of invasive fungal infections in patients withhematological malignancies: a single-center real-life experience

Epidemiology and analysis of invasive fungal infections in patients withhematological malignancies: a single-center real-life experience

Characteristics and risk factors for mortality of invasive non‐Aspergillus mould infections in patients with haematologic diseases: A single‐centre 7‐year cohort study

EQUAL Aspergillosis Score 2018: An ECMM score derived from current guidelines to measure QUALity of the clinical management of invasive pulmonary aspergillosis

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