Invasive infections due to filamentous fungi other than Aspergillus: Epidemiology and determinants of mortality

M. Slavin, S. van Hal, T. C. Sorrell, A. Lee, D. J. Marriott, K. Daveson, K. Kennedy, C. Halliday, E. Athan, N. Bak, E. Cheong, C. H. Heath, C. Orla Morrissey, S. Kidd, R. Beresford, C. Blyth, T. M. Korman, J. Owen Robinson, W. Meyer, S. C. A. Chen & 1 others Australia and New Zealand Mycoses Interest Group

Research output: Contribution to journalArticleResearchpeer-review

Abstract

The epidemiology of invasive fungal disease (IFD) due to filamentous fungi other than Aspergillus may be changing. We analysed clinical, microbiological and outcome data in Australian patients to determine the predisposing factors and identify determinants of mortality. Proven and probable non- Aspergillus mould infections (defined according to modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria) from 2004 to 2012 were evaluated in a multicentre study. Variables associated with infection and mortality were determined. Of 162 episodes of non- Aspergillus IFD, 145 (89.5%) were proven infections and 17 (10.5%) were probable infections. The pathogens included 29 fungal species/species complexes; mucormycetes (45.7%) and Scedosporium species (33.3%) were most common. The commonest comorbidities were haematological malignancies (HMs) (46.3%) diabetes mellitus (23.5%), and chronic pulmonary disease (16%); antecedent trauma was present in 21% of cases. Twenty-five (15.4%) patients had no immunocompromised status or comorbidity, and were more likely to have acquired infection following major trauma (p <0.01); 61 (37.7%) of cases affected patients without HMs or transplantation. Antifungal therapy was administered to 93.2% of patients (median 68 days, interquartile range 19-275), and adjunctive surgery was performed in 58.6%. The all-cause 90-day mortality was 44.4%; HMs and intensive-care admission were the strongest predictors of death (both p <0.001). Survival varied by fungal group, with the risk of death being significantly lower in patients with dematiaceous mould infections than in patients with other non- Aspergillus mould infections. Non- Aspergillus IFD affected diverse patient groups, including non-immunocompromised hosts and those outside traditional risk groups; therefore, definitions of IFD in these patients are required. Given the high mortality, increased recognition of infections and accurate identification of the causative agent are required.

Original languageEnglish
Article number490
Number of pages10
JournalClinical Microbiology and Infection
Volume21
Issue number5
DOIs
Publication statusPublished - 1 May 2015

Keywords

  • Determinants of outcome
  • Epidemiology
  • Filamentous fungus
  • Non-Aspergillus moulds
  • Predisposing factors

Cite this

Slavin, M., van Hal, S., Sorrell, T. C., Lee, A., Marriott, D. J., Daveson, K., ... Australia and New Zealand Mycoses Interest Group (2015). Invasive infections due to filamentous fungi other than Aspergillus: Epidemiology and determinants of mortality. Clinical Microbiology and Infection, 21(5), [490]. https://doi.org/10.1016/j.cmi.2014.12.021
Slavin, M. ; van Hal, S. ; Sorrell, T. C. ; Lee, A. ; Marriott, D. J. ; Daveson, K. ; Kennedy, K. ; Halliday, C. ; Athan, E. ; Bak, N. ; Cheong, E. ; Heath, C. H. ; Morrissey, C. Orla ; Kidd, S. ; Beresford, R. ; Blyth, C. ; Korman, T. M. ; Owen Robinson, J. ; Meyer, W. ; Chen, S. C. A. ; Australia and New Zealand Mycoses Interest Group. / Invasive infections due to filamentous fungi other than Aspergillus : Epidemiology and determinants of mortality. In: Clinical Microbiology and Infection. 2015 ; Vol. 21, No. 5.
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abstract = "The epidemiology of invasive fungal disease (IFD) due to filamentous fungi other than Aspergillus may be changing. We analysed clinical, microbiological and outcome data in Australian patients to determine the predisposing factors and identify determinants of mortality. Proven and probable non- Aspergillus mould infections (defined according to modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria) from 2004 to 2012 were evaluated in a multicentre study. Variables associated with infection and mortality were determined. Of 162 episodes of non- Aspergillus IFD, 145 (89.5{\%}) were proven infections and 17 (10.5{\%}) were probable infections. The pathogens included 29 fungal species/species complexes; mucormycetes (45.7{\%}) and Scedosporium species (33.3{\%}) were most common. The commonest comorbidities were haematological malignancies (HMs) (46.3{\%}) diabetes mellitus (23.5{\%}), and chronic pulmonary disease (16{\%}); antecedent trauma was present in 21{\%} of cases. Twenty-five (15.4{\%}) patients had no immunocompromised status or comorbidity, and were more likely to have acquired infection following major trauma (p <0.01); 61 (37.7{\%}) of cases affected patients without HMs or transplantation. Antifungal therapy was administered to 93.2{\%} of patients (median 68 days, interquartile range 19-275), and adjunctive surgery was performed in 58.6{\%}. The all-cause 90-day mortality was 44.4{\%}; HMs and intensive-care admission were the strongest predictors of death (both p <0.001). Survival varied by fungal group, with the risk of death being significantly lower in patients with dematiaceous mould infections than in patients with other non- Aspergillus mould infections. Non- Aspergillus IFD affected diverse patient groups, including non-immunocompromised hosts and those outside traditional risk groups; therefore, definitions of IFD in these patients are required. Given the high mortality, increased recognition of infections and accurate identification of the causative agent are required.",
keywords = "Determinants of outcome, Epidemiology, Filamentous fungus, Non-Aspergillus moulds, Predisposing factors",
author = "M. Slavin and {van Hal}, S. and Sorrell, {T. C.} and A. Lee and Marriott, {D. J.} and K. Daveson and K. Kennedy and K. Hajkowicz and C. Halliday and E. Athan and N. Bak and E. Cheong and Heath, {C. H.} and Morrissey, {C. Orla} and S. Kidd and R. Beresford and C. Blyth and Korman, {T. M.} and {Owen Robinson}, J. and W. Meyer and Chen, {S. C. A.} and {Australia and New Zealand Mycoses Interest Group} and J. Clark and J. McCormack and D. Looke and Playford, {E. Geoffrey} and T. Gottlieb and B. McMullan and M. Ananda-Rajah and N. Macesic and K. Thursky and I. Arthur and A. Morris and S. Chambers",
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Slavin, M, van Hal, S, Sorrell, TC, Lee, A, Marriott, DJ, Daveson, K, Kennedy, K, Halliday, C, Athan, E, Bak, N, Cheong, E, Heath, CH, Morrissey, CO, Kidd, S, Beresford, R, Blyth, C, Korman, TM, Owen Robinson, J, Meyer, W, Chen, SCA & Australia and New Zealand Mycoses Interest Group 2015, 'Invasive infections due to filamentous fungi other than Aspergillus: Epidemiology and determinants of mortality' Clinical Microbiology and Infection, vol. 21, no. 5, 490. https://doi.org/10.1016/j.cmi.2014.12.021

Invasive infections due to filamentous fungi other than Aspergillus : Epidemiology and determinants of mortality. / Slavin, M.; van Hal, S.; Sorrell, T. C.; Lee, A.; Marriott, D. J.; Daveson, K.; Kennedy, K.; Halliday, C.; Athan, E.; Bak, N.; Cheong, E.; Heath, C. H.; Morrissey, C. Orla; Kidd, S.; Beresford, R.; Blyth, C.; Korman, T. M.; Owen Robinson, J.; Meyer, W.; Chen, S. C. A.; Australia and New Zealand Mycoses Interest Group.

In: Clinical Microbiology and Infection, Vol. 21, No. 5, 490, 01.05.2015.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Invasive infections due to filamentous fungi other than Aspergillus

T2 - Epidemiology and determinants of mortality

AU - Slavin, M.

AU - van Hal, S.

AU - Sorrell, T. C.

AU - Lee, A.

AU - Marriott, D. J.

AU - Daveson, K.

AU - Kennedy, K.

AU - Hajkowicz, K.

AU - Halliday, C.

AU - Athan, E.

AU - Bak, N.

AU - Cheong, E.

AU - Heath, C. H.

AU - Morrissey, C. Orla

AU - Kidd, S.

AU - Beresford, R.

AU - Blyth, C.

AU - Korman, T. M.

AU - Owen Robinson, J.

AU - Meyer, W.

AU - Chen, S. C. A.

AU - Australia and New Zealand Mycoses Interest Group

AU - Clark, J.

AU - McCormack, J.

AU - Looke, D.

AU - Playford, E. Geoffrey

AU - Gottlieb, T.

AU - McMullan, B.

AU - Ananda-Rajah, M.

AU - Macesic, N.

AU - Thursky, K.

AU - Arthur, I.

AU - Morris, A.

AU - Chambers, S.

PY - 2015/5/1

Y1 - 2015/5/1

N2 - The epidemiology of invasive fungal disease (IFD) due to filamentous fungi other than Aspergillus may be changing. We analysed clinical, microbiological and outcome data in Australian patients to determine the predisposing factors and identify determinants of mortality. Proven and probable non- Aspergillus mould infections (defined according to modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria) from 2004 to 2012 were evaluated in a multicentre study. Variables associated with infection and mortality were determined. Of 162 episodes of non- Aspergillus IFD, 145 (89.5%) were proven infections and 17 (10.5%) were probable infections. The pathogens included 29 fungal species/species complexes; mucormycetes (45.7%) and Scedosporium species (33.3%) were most common. The commonest comorbidities were haematological malignancies (HMs) (46.3%) diabetes mellitus (23.5%), and chronic pulmonary disease (16%); antecedent trauma was present in 21% of cases. Twenty-five (15.4%) patients had no immunocompromised status or comorbidity, and were more likely to have acquired infection following major trauma (p <0.01); 61 (37.7%) of cases affected patients without HMs or transplantation. Antifungal therapy was administered to 93.2% of patients (median 68 days, interquartile range 19-275), and adjunctive surgery was performed in 58.6%. The all-cause 90-day mortality was 44.4%; HMs and intensive-care admission were the strongest predictors of death (both p <0.001). Survival varied by fungal group, with the risk of death being significantly lower in patients with dematiaceous mould infections than in patients with other non- Aspergillus mould infections. Non- Aspergillus IFD affected diverse patient groups, including non-immunocompromised hosts and those outside traditional risk groups; therefore, definitions of IFD in these patients are required. Given the high mortality, increased recognition of infections and accurate identification of the causative agent are required.

AB - The epidemiology of invasive fungal disease (IFD) due to filamentous fungi other than Aspergillus may be changing. We analysed clinical, microbiological and outcome data in Australian patients to determine the predisposing factors and identify determinants of mortality. Proven and probable non- Aspergillus mould infections (defined according to modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria) from 2004 to 2012 were evaluated in a multicentre study. Variables associated with infection and mortality were determined. Of 162 episodes of non- Aspergillus IFD, 145 (89.5%) were proven infections and 17 (10.5%) were probable infections. The pathogens included 29 fungal species/species complexes; mucormycetes (45.7%) and Scedosporium species (33.3%) were most common. The commonest comorbidities were haematological malignancies (HMs) (46.3%) diabetes mellitus (23.5%), and chronic pulmonary disease (16%); antecedent trauma was present in 21% of cases. Twenty-five (15.4%) patients had no immunocompromised status or comorbidity, and were more likely to have acquired infection following major trauma (p <0.01); 61 (37.7%) of cases affected patients without HMs or transplantation. Antifungal therapy was administered to 93.2% of patients (median 68 days, interquartile range 19-275), and adjunctive surgery was performed in 58.6%. The all-cause 90-day mortality was 44.4%; HMs and intensive-care admission were the strongest predictors of death (both p <0.001). Survival varied by fungal group, with the risk of death being significantly lower in patients with dematiaceous mould infections than in patients with other non- Aspergillus mould infections. Non- Aspergillus IFD affected diverse patient groups, including non-immunocompromised hosts and those outside traditional risk groups; therefore, definitions of IFD in these patients are required. Given the high mortality, increased recognition of infections and accurate identification of the causative agent are required.

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