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

Abstract

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.

Has the mortality from pulmonary mucormycosis changed over time? A systematic review and meta-analysis

“…[76,92]. Thus, patients with localized disease and no significant comorbidities would have been operated, while patients with extensive disease would have been managed medically, leading to a selection bias [15].…”

“…Therefore, it is commonly believed that the survival of mucormycosis, including PM, has improved over time. Some series also suggest excellent results in PM (up to 90% survival at 6 weeks) with combined medicalesurgical therapy [14,15]. The advent of newer mould-active triazoles and better surgical techniques could contribute to better outcomes [16e20].…”

Consensus guidelines for the diagnosis and management of invasive fungal disease due to moulds other than Aspergillus in the haematology/oncology setting, 2021

“…An Australian study from 2004 to 2012 showed that Mucorales accounted for 45.7% (74/162) of NAMI 13 . Haematological malignancy (48%) has been identified as the most common risk factor 12 . Contrary to European studies, Lichtheimia spp.…”

“…Mucormycosis is the most common NAMI 6,9–12 . An Australian study from 2004 to 2012 showed that Mucorales accounted for 45.7% (74/162) of NAMI 13 .…”

Radiological CT Patterns and Distribution of Invasive Pulmonary Aspergillus, Non-Aspergillus, Cryptococcus and Pneumocystis Jirovecii Mold Infections – A Multicenter Study

“…Therefore, early and accurate diagnosis of invasive fungal infection (IFI) is important to improve patient survival [3,4]. When neutropenia lasts more than 7 days, fungal infections may occur (aspergillosis, candidiasis, mucormycosis) [5][6][7]. The clinical diagnosis of fungal pulmonary infection is based on host factors (i. e., immune status, neutropenic fever), clinical signs (unexplained fever despite broad-spectrum antibiotics), microbiological evidence of infection, and specific patterns on computed tomography (CT) imaging [1,[8][9][10].…”