Epidemiological trends in invasive aspergillosis in France: the SAIF network (2005–2007)

Abstract

A prospective (2005-2007) hospital-based multicentre surveillance of EORTC/MSG-proven or probable invasive aspergillosis (IA) cases whatever the underlying diseases was implemented in 12 French academic hospitals. Admissions per hospital and transplantation procedures were obtained. Cox regression models were used to determine risk factors associated with the 12-week overall mortality. With 424 case-patients included, the median incidence/hospital was 0.271/10(3) admissions (range 0.072-0.910) without significant alteration of incidence and seasonality over time. Among the 393 adults (62% men, 56 years (16-84 years)), 15% had proven IA, 78% haematological conditions, and 92.9% had lung involvement. Acute leukaemia (34.6%) and allogeneic stem cell transplantation (21.4%) were major host factors, together with chronic lymphoproliferative disorders (21.6%), which emerged as a new high-risk group. The other risk host factors consisted of solid organ transplantation (8.7%), solid tumours (4.3%), systemic inflammatory diseases (4.6%) and chronic respiratory diseases (2.3%). Serum galactomannan tests were more often positive (≥69%) for acute leukaemia and allogeneic stem cell transplantation than for the others (<42%; p <10(-3)). When positive (n = 245), cultures mainly yielded Aspergillus fumigatus (79.7%). First-line antifungal therapy consisted of voriconazole, caspofungin, lipid formulations of amphotericin, or any combination therapy (52%, 14%, 8% and 19.9%, respectively). Twelve-week overall mortality was 44.8% (95% CI, 39.8-50.0); it was 41% when first-line therapy included voriconazole and 60% otherwise (p <0.001). Independent factors for 12-week mortality were older age, positivity for both culture and galactomannan and central nervous system or pleural involvement, while any strategy containing voriconazole was protective.

Persistent poor long-term prognosis of allogeneic hematopoietic stem cell transplant recipients surviving invasive aspergillosis

“…Two other large retrospective and two prospective series of patients highlight the beneficial role of voriconazole on 12-week survival. 2,4,6,18 In addition, analyses of prognostic factors verify the other previously recognized important prognostic factors (uncontrolled GVHD, steroids dose). 2,4,7,19,20 There are few reports on the long-term survival (≥ one year) of allogeneic HSCT recipients with IA.…”

Serious fungal infections in Ecuador

“…It is assumed that non-AML haematological conditions in total represent the same population incidence of invasive aspergillosis (IA) as AML patients; in each group there is an incidence of approximately 10% [28]. Further, it is assumed that the incidence of IA in allogeneic haematopoietic stem cell transplants is 8% [28].…”

“…Further, it is assumed that the incidence of IA in allogeneic haematopoietic stem cell transplants is 8% [28]. IA is also associated with solid organ transplantation, although the reported incidence varies by both dataset and anatomical site.…”

Tissue Penetration of Antifungal Agents

“…Mortality from IFI remains high (e.g., that from aspergillosis is Ϸ50% [3,4], and that from candidemia is 10 to 49% [5,6,7]). An understanding of the pharmacological properties of any antifungal agent is crucial for optimizing patient outcomes for all these infections (8).…”