The Nationwide Austrian Aspergillus Registry: a prospective data collection on epidemiology, therapy and outcome of invasive mould infections in immunocompromised and/or immunosuppressed patients

Abstract

A prospective, observational, multicentre study was performed to assess the incidence, diagnosis, epidemiology and outcome of invasive mould infections (IMIs) reported to the Nationwide Austrian Aspergillus Registry. In total, 186 cases were recorded, corresponding to an annual incidence of 42 cases/1000 patients at risk or 2.36 cases/100000 inhabitants. Patients with acute myelogenous leukaemia (34%) and lung transplant recipients (17%) are currently at highest risk for IMI, followed by a mixed population with impaired immunity (14%). In total, 34%, 30% and 36% were proven, probable and possible cases of IMI. Predominant pathogens were Aspergillus spp. (67%), followed by the zygomycetes (28%). Voriconazole was the most frequently administered agent (38%), followed by caspofungin (20%) and posaconazole (19%). Eighty patients (43%) received antifungal prophylaxis for ≥7 days, 30% of whom (24 patients) suffered from a breakthrough infection. The overall crude 12-week mortality was 34%. Multivariate analysis showed that outcome and survival did not correlate with the status of fungal disease, breakthrough infection, fungal species or age (P>0.05). Aspergillosis remains the most commonly identified IMI amongst immunocompromised and/or immunosuppressed patients, but other moulds constitute a significant problem. Survival from IMIs appears to have improved and the main challenge is to overcome breakthrough fungal infections.

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

“…[1][2][3][4][5] Voriconazole treatment appears to be independently associated with improved survival through a decrease in IAattributable mortality. 1,2,4,6,7 These findings support other available evidence in legitimizing the universal recommendation of voriconazole as a first-line IA treatment in hematologic and other immunocompromised patients. [8][9][10][11] Most studies have examined 3-, 4-or 6-month survival rates of HSCT recipients with IA, but immunosuppression is a persistent problem in this patient population.…”

Comparative clinical effectiveness of prophylactic voriconazole/posaconazole to fluconazole/itraconazole in patients with acute myeloid leukemia/myelodysplastic syndrome undergoing cytotoxic chemotherapy over a 12-year period

“…Multiple prophylactic azole drugs m.R. ananda-Rajah et al 462 haematologica | 2012; 97(3) 4 Pulmonary lesions treated for suspected invasive fungal infection but not meeting consensus criteria. 11 5 Comparing discontinuation in the itraconazole vs. voriconazole+posaconazole groups combined.…”

“…EAFT was higher in the combined fluconazole/itraconazole compared to the voriconazole/ posaconazole groups (31% vs. 8.5%, P<0.001) as were pulmonary lesions on computed-tomography treated for suspected IFD but not meeting criteria for possible-IFD (10% vs. 4 …”

“…1,2 Invasive aspergillosis (IA) remains the commonest cause of IFD and crude mortality remains considerable at 33-47%. 1,3,4 For patients surviving IFDs, delays or modifications to curative chemotherapy may compromise long-term prognosis. 2,5 Poor clinical outcomes coupled with diagnostic uncertainty underlies the rationale for antifungal prophylaxis, the efficacy of which in preventing IFD and improving short-term survival has best been demonstrated for posaconazole in AML/MDS patients receiving remission-induction chemotherapy.…”

Development and application of two independent real-time PCR assays to detect clinically relevant Mucorales species

“…Fungi of the families Saksenaceae and Syncephalastraceae are uncommon pathogens and are typically restricted to tropical areas, affecting immunocompetent hosts (Petrikkos et al, 2012). Whereas the exact incidence of mucormycosis is unclear and probably underestimated, an Austrian observational study recently reported 28% of their collected invasive mould infections were caused by Mucorales, equal to 1.2% of at-risk patients (Perkhofer et al, 2010). Other studies reported up to 13% incidence in high-risk patients, and risk of IFD was mainly associated with haematological malignancies and diabetes mellitus (Petrikkos et al, 2012).…”