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., Hajkowicz, K., Halliday, C., Athan, E., Bak, N., Cheong, E., Heath, C. H., Orla Morrissey, C., Kidd, S., Beresford, R., Blyth, C., Korman, T. M., Owen Robinson, J., Meyer, W. and Chen, S. C. 2015, Invasive infections due to filamentous fungi other than Aspergillus: epidemiology and determinants of mortality, Clinical microbiology and infection, vol. 21, no. 5, pp. 490.e1-490.e10, doi: 10.1016/j.cmi.2014.12.021.

Title Invasive infections due to filamentous fungi other than Aspergillus: epidemiology and determinants of mortality
Author(s) Slavin, M.
van Hal, S.
Sorrell, T. C.
Lee, A.
Marriott, D. J.
Daveson, K.
Kennedy, K.
Hajkowicz, K.
Halliday, C.
Athan, E.ORCID iD for Athan, E.
Bak, N.
Cheong, E.
Heath, C. H.
Orla Morrissey, C.
Kidd, S.
Beresford, R.
Blyth, C.
Korman, T. M.
Owen Robinson, J.
Meyer, W.
Chen, S. C.
Journal name Clinical microbiology and infection
Volume number 21
Issue number 5
Start page 490.e1
End page 490.e10
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2015-05
ISSN 1469-0691
Keyword(s) Determinants of outcome
filamentous fungus
non-Aspergillus moulds
predisposing factors
Australia and New Zealand Mycoses Interest Group
Summary 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.
Language eng
DOI 10.1016/j.cmi.2014.12.021
Field of Research 1103 Clinical Sciences
Socio Economic Objective 929999 Health not elsewhere classified
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2015, Elsevier
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