Invasive aspergillosis in adult patients in Australia and New Zealand: 2017-2020

被引：8

作者：

Tio, Shio Yen ^{[1
,2
,3
,4
]}

Chen, Sharon C. -A. ^{[5
]}

Hamilton, Kate ^{[5
]}

Heath, Christopher H. ^{[6
,7
,8
]}

Pradhan, Alyssa ^{[9
,10
]}

Morris, Arthur J. ^{[11
]}

Korman, Tony M. ^{[12
,13
]}

Morrissey, Orla ^{[14
,15
]}

Halliday, Catriona L. ^{[5
,10
]}

Kidd, Sarah ^{[16
]}

Spelman, Timothy ^{[17
,18
]}

Brell, Nadiya ^{[19
]}

McMullan, Brendan ^{[20
,21
]}

Clark, Julia E. ^{[22
,23
]}

Mitsakos, Katerina ^{[24
]}

Hardiman, Robyn P. ^{[24
]}

Williams, Phoebe ^{[20
,25
]}

Campbell, Anita J. ^{[26
,27
]}

Beardsley, Justin ^{[28
,29
,30
]}

Van Hal, Sebastiaan ^{[10
,31
]}

Yong, Michelle K. ^{[1
,2
,3
,4
]}

Worth, Leon J. ^{[1
,2
,4
]}

Slavin, Monica A. ^{[1
,2
,3
,4
]}

机构：

[1] Peter MacCallum Canc Ctr, Dept Infect Dis, 305 Grattan St, Melbourne, Vic 3000, Australia

[2] Natl Ctr Infect Canc, Melbourne, Australia

[3] Royal Melbourne Hosp, Dept Infect Dis, Melbourne, Australia

[4] Univ Melbourne, Sir Peter MacCallum Dept Oncol, Melbourne, Vic, Australia

[5] Westmead Hosp, Inst Clin Pathol & Med Res, New South Wales Hlth Pathol, Ctr Infect Dis & Microbiol Lab Serv, Sydney, Australia

[6] PathWest Lab Med, Dept Microbiol, Murdoch, WA, Australia

[7] Fiona Stanley Hosp, Dept Infect Dis, Murdoch, WA, Australia

[8] Univ Western Australia, Dept Med, Crawley, WA, Australia

[9] Prince Wales Hosp, Southeast Sydney LHD, NSW Hlth Pathol, Sydney, Australia

[10] Univ Sydney, Sch Med, Sydney, Australia

[11] Auckland City Hosp, 2 Pk Rd Grafton, Auckland 1023, New Zealand

[12] Monash Univ, Clayton, Vic, Australia

[13] Monash Hlth, Clayton, Vic, Australia

[14] Alfred Hlth, Dept Infect Dis, Melbourne, Vic, Australia

[15] Monash Univ, Melbourne, Vic, Australia

[16] SA Pathol, Microbiol & Infect Dis, Natl Mycol Reference Ctr, Adelaide, SA, Australia

[17] Peter MacCallum Canc Ctr, Dept Hlth Serv Res, Melbourne, Australia

[18] Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden

[19] Univ New South Wales, Sydney, NSW, Australia

[20] Sydney Childrens Hosp, Dept Immunol & Infect Dis, Randwick, NSW, Australia

[21] UNSW, Fac Med & Hlth, Sch Clin Med, Sydney, NSW, Australia

[22] Childrens Hlth Queensland, Queensland Childrens Hosp, Infect Management Serv, Brisbane 4101, Australia

[23] Univ Queensland, Sch Clin Med, CHQCU, Brisbane, Australia

[24] Royal North Shore Hosp, Dept Infect Dis & Microbiol, Sydney, Australia

[25] Univ Sydney, Fac Med, Sch Publ Hlth, Sydney, Australia

[26] Perth Childrens Hosp, Dept Infect Dis, Perth, WA, Australia

[27] Univ Western Australia, Telethon Kids Inst, Wesfarmers Ctr Vaccines & Infect Dis, Perth, WA, Australia

[28] Univ Sydney, Infect Dis Inst, Sydney, Australia

[29] NSW Hlth, Westmead Hosp, Western Sydney LHD, Westmead, NSW, Australia

[30] Westmead Inst Med Res, Westmead, NSW, Australia

[31] Royal Prince Alfred Hosp, Dept Infect Dis & Microbiol, Camperdown, NSW, Australia

来源：

LANCET REGIONAL HEALTH-WESTERN PACIFIC | 2023年 / 40卷

基金：

英国医学研究理事会;

关键词：

Invasive aspergillosis; Epidemiology; Outcome; Australasia; ACUTE MYELOID-LEUKEMIA; PULMONARY ASPERGILLOSIS; ANTIFUNGAL RESISTANCE; FILAMENTOUS-FUNGI; AMPHOTERICIN-B; PCR ASSAY; INFECTIONS; IDENTIFICATION; CANDIDA; DETECT;

D O I：

10.1016/j.lanwpc.2023.100888

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background New and emerging risks for invasive aspergillosis (IA) bring the need for contemporary analyses of the epidemiology and outcomes of IA, in order to improve clinical practice.Methods The study was a retrospective, multicenter, cohort design of proven and probable IA in adults from 10 Australasian tertiary centres (January 2017-December 2020). Descriptive analyses were used to report patients' demographics, predisposing factors, mycological characteristics, diagnosis and management. Accelerated failure-time model was employed to determine factor(s) associated with 90-day all-cause mortality (ACM).Findings Of 382 IA episodes, 221 (in 221 patients) fulfilled inclusion criteria - 53 proven and 168 probable IA. Median patient age was 61 years (IQR 51-69). Patients with haematologic malignancies (HM) comprised 49.8% of cases. Fifteen patients (6.8%) had no pre-specified immunosuppression and eleven patients (5.0%) had no documented comorbidity. Only 30% of patients had neutropenia. Of 170 isolates identified, 40 (23.5%) were identified as non-Aspergillus fumigatus species complex. Azole-resistance was present in 3/46 (6.5%) of A. fumigatus sensu stricto isolates. Ninety-day ACM was 30.3%. HM (HR 1.90; 95% CI 1.04-3.46, p = 0.036) and ICU admission (HR 4.89; 95% CI 2.93-8.17, p < 0.001) but not neutropenia (HR 1.45; 95% CI 0.88-2.39, p = 0.135) were associated with mortality. Chronic kidney disease was also a significant predictor of death in the HM subgroup (HR 3.94; 95% CI 1.15-13.44, p = 0.028).Interpretation IA is identified in high number of patients with mild/no immunosuppression in our study. The relatively high proportion of non -A. fumigatus species complex isolates and 6.5% azole-resistance rate amongst A. fumigatus sensu stricto necessitates accurate species identification and susceptibility testing for optimal patient outcomes.Copyright (c) 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

引用

页数：14

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