SummaryThe incidence and prevalence of fungal infections in Russia is unknown. We estimated the burden of fungal infections in Russia according to the methodology of the LIFE program (www.LIFE-worldwide.org). The total number of patients with serious and chronic mycoses in Russia in 2011 was three million. Most of these patients (2607 494) had superficial fungal infections (recurrent vulvovaginal candidiasis, oral and oesophageal candidiasis with HIV infection and tinea capitis). Invasive and chronic fungal infections (invasive candidiasis, invasive and chronic aspergillosis, cryptococcal meningitis, mucormycosis and Pneumocystis pneumonia) affected 69 331 patients. The total number of adults with allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitisation was 406 082.

Background: Patients with haematological malignancies often require central venous access for administration of chemotherapy and blood products. Infection remains one of the commonest complications of these devices and is associated with significant morbidity and sometimes mortality. Aims:The purpose of our study is to identify clinical and laboratory factors which may predict a higher risk of line-associated bloodstream infections in patients with haematological malignancies. Methods: Patients treated for haematological malignancies at our centre between January 2016 and December 2018 were retrospectively identified. Only patients who had either a tunnelled line or peripherally-inserted central catheter (PICC) were included in the study. Line-associated bloodstream infections were recorded and the predictive value of a number of baseline clinical and laboratory parameters for infections was assessed. Results: One hundred and fifty-three patients were identified during the study period. The haematological diagnosis was as follows: acute leukaemia in 63 (41.2%) patients, lymphoma in 81 (52.9%) and other diagnoses in nine (5.9%). One hundred and twenty-five patients (81.7%) had a tunnelled line while 28 patients (18.3%) had a PICC. The total duration of follow-up was 10,416 line-days with a median of 55 days. The median in-situ duration for tunnelled lines was 38 days (range 4-150 days) while that for PICCs was 17 days (range 2-145 days) (P = 0.02). Bloodstream infections were identified in 58 (37.9%) patients, with 28 patients (18.3%) satisfying the criteria for a catheter-related bloodstream infection (CRBSI). The overall infection rate was 5.5 infections per 1,000 line-days. There was no significant difference in the rates of infection between tunnelled lines and PICC lines (P = 0.25). On multivariate analysis for the whole group, line-associated infections were more likely in patients with acute leukaemia (P < 0.001), those receiving corticosteroids as part of the chemotherapy regimen (P = 0.01) and those with neutropenia (absolute neutrophil count <1.0 x 10 9 /L) at the time of line placement (P = 0.03). On univariate analysis, predictive factors for line infections in tunnelled catheters included acute leukaemia (P < 0.001), steroid use (P = 0.01), younger age (P = 0.04) and total number of line-days with neutropenia (P = 0.04). On multivariate analysis only acute leukaemia (P < 0.001) and steroid use (P = 0.06) retained independent prognostic significance. For PICCs only neutropenia at the time of placement was predictive for an increased risk of infection (P = 0.01). Summary/Conclusion:In conclusion this study identified acute leukaemia, corticosteroid use and neutropenia at the time of catheter placement as clinical predictors of infection in patients with haematological malignancy.

ВведениеAspergillus spp. -это возбудители инвазивного аспергиллеза (ИА) и хронического аспергиллеза легких (ХАЛ), а также источники большого коли-чества аллергенов [1, 2]

Russia; 6-8 L'va Tolstogo St., 197022 Saint Petersburg, Russia; 4 Leningrad Regional Clinical Hospital; 45-49 Lunacharskogo Prospect, 197022 Saint Petersburg, Russia In the retrospective multicenter study during [2007][2008][2009][2010][2011][2012][2013][2014][2015][2016][2017] we included 59 oncohematological patients with mucormycosis and 541 patients with invasive aspergillosis. Our study showed that mucomorhycosis more often developed in children and adolescents (p = 0.001), and after «graft versus host» disease development (p = 0.0001). Patients with mucormycosis were more immunosuppressed: severe neutropenia was in 88 % vs. 82 %, median duration of neutropenia -30 days vs. 14 days, p = 0.0001, lymphocytopenia -77 % vs. 65 %, median duration of lymphocytopenia -25 days vs. 14 days, p = 0.001. The main sites of infection were lungs, nevertheless in patients with mucormycosis it was less frequent (73 % vs. 97 %, p = 0.02), but more frequent were ≥2 organs involvement (42 % vs. 8 %, p = 0.001) and paranasal sinuses involvement (15 % vs. 6 %, p = 0.04

We present the results of a prospective multicenter study of risk factors, etiology, clinical features, and treatment outcomes for mucormycosis in patients with COVID-19 (COVID-M) in the Russian Federation.The study included 60 adult patients with COVID-M. To analyze risk factors for COVID-M, we conducted a case-control study. The control group included 60 adult patients with COVID-19 without mucormycosis. To analyze the clinical manifestations of COVID-M, we created a control group of hematological patients with mucormycosis examined in 2011–2020.In patients with COVID-19, the risk of developing mucormycosis was significantly increased with diabetes mellitus (OR=49) and overweight (OR=4,75), as well as with the use of high (≥100 mg per day for prednisolone) doses of glucocorticosteroids (OR= 4,762), especially ≥10 days (OR=25,4). The main localization of mucormycosis in patients with COVID-19 was the paranasal sinuses (95%) and the orbit (68%). Involvement of ≥2 organs was identified in 70% of patients. The main causative agents of mucormycosis were Rhizopus arrhizus (43%) and unidentified mucormycetes (36%).90-days overall survival of patients with mucormycosis and COVID-19 – 71%. The stay in the ICU (p=0,01), the use of mechanical ventilation (p=0,0481), the presence of CVC (p=0,049), CNS damage (p=0,016) and ≥ 2 organs (p=0,048) significantly worsened the prognosis of the disease. The best prognosis was in patients who received antifungal therapy (p=0,03875) and surgical treatment (p=0,046).