Clinical outcome and prognostic factors associated with invasive pulmonary aspergillosis: An 11-year follow-up report from Taiwan

Abstract

BackgroundInvasive pulmonary aspergillosis (IPA) has high mortality rate but prognostic factors are not well established. The aim of our study was to evaluate the trend in in-hospital mortality over a period of 11 years and identify factors affecting the clinical outcomes of patients with IPA.MethodWe conducted a nationwide inpatient population study using data from the Taiwan National Health Insurance Research Database. A total of 407 IPA patients from 2002 to 2012 were included in the study. Differences in demographics, comorbidities, and treatment were evaluated between in-hospital death group and survival group. Multivariate analysis was also performed to identify risk factors for mortality.ResultMale patients represented 63.14% of the patients (n = 257) and the mean age was 53.15 ± 20.93 years. Hematological cancer (n = 216, 53.07%) and diabetes mellitus (n = 75, 18.43%) were the most common underlying conditions. The overall case fatality rate was 30.22% with female slightly higher then male (32.67% versus 28.79%). The in-hospital case fatality rate increased since 2002 and peaked in 2006. It then declined over time with an in-hospital mortality of 25% in 2012. The in-hospital death group had a higher intubation rate (p<0.0001), a longer ICU stay (p = 0.0062), higher percentages of DM (p = 0.0412) and COPD (p = 0.0178), and a lower percentage of hematological cancer (p = 0.0079) as compared to survivor. The in-hospital death group was more likely to have steroid treatment (p<0.0001), develop acute renal failure (p<0.0001) and other infectious diseases (p = 0.0008) during hospitalization. Multivariate analysis identified female gender, older age (≥ 65 years old), intubation, bone marrow transplantation, acute renal failure, other infectious diseases and steroid use as predictive factors for mortality.ConclusionThe present study shows the trend in mortality among patients with IPA over an 11-year period. Female gender, older age, intubation, bone marrow transplantation, acute renal failure, other infectious diseases and steroid use were identified as risk factors for mortality.

A nationwide passive surveillance on fungal infections shows a low burden of azole resistance in molds and yeasts in Tyrol, Austria

“…Invasive fungal infections (IFI) are associated with a high rate of morbidity and mortality in at-risk patients [ 1 ]. Candida and Aspergillus species remain the predominant pathogens with a shift towards resistant fungal pathogens being noted [ 2 ].…”

Molecular Identification, Antifungal Susceptibility Testing, and Mechanisms of Azole Resistance in Aspergillus Species Received within a Surveillance Program on Antifungal Resistance in Spain

“…I nvasive fungal infections (IFIs) have suffered a significant increase over the last decades, due mainly to the rise in patients subjected to strong immunosuppression (1,2). These infections present high associated mortality and morbidity rates (1,3,4), and a broad range of molds have been reported to cause them (such as Aspergillus spp., Scedosporium spp., Fusarium spp., or Mucorales), with a shift toward new species that are emerging.…”

Factors influencing susceptibility testing of antifungal drugs: a critical review of document M27-A4 from the Clinical and Laboratory Standards Institute (CLSI)

“…Invasive fungal infections are often associated with significant morbidity and mortality, a problem which is aggravated by the need for sophisticated diagnostic approaches and therapeutic schemes [1,2]. Despite improvements of diagnostic tools and therapeutic options [3][4][5][6], fungal infections are a major cause of high morbidity and mortality rates in predominantly immunocompromised human patients, w ith Candida, Cryptococcus, and Aspergillus genera being the main etiological agents of these infections [7,8]. In immunocompromised patients, mycoses generally behave as opportunistic infections, causing invasive and often fatal disease [9].…”