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http://hdl.handle.net/2445/201926
Title: | Breakthrough invasive fungal infection among patients with haematologic malignancies: A national, prospective, and multicentre study |
Author: | Puerta Alcalde, Pedro Monzó Gallo, Patricia Aguilar-Guisado, Manuela Ramos, Juan Carlos Laporte Amargós, Júlia Machado, Marina Martín Davila, Pilar Franch Sarto, Mireia Sánchez Romero, Isabel Badiola, Jon Gómez, Lucia Ruiz Camps, Isabel Yáñez, Lucrecia Vázquez, Lourdes Chumbita, Mariana Marco, Francesc Soriano Viladomiu, Alex González, Pedro Fernández Cruz, Ana Batlle, Montserrat Fortún, Jesús Guinea, Jesús Gudiol, Carlota García, Julio Ruiz Pérez de Pipaón, Maite Alastruey Izquierdo, Ana García Vidal, Carolina |
Keywords: | Hematologia Micosi Hematology Mycosis |
Issue Date: | 16-May-2023 |
Publisher: | Elsevier BV |
Abstract: | Objectives: We describe the current epidemiology, causes, and outcomes of breakthrough invasive fungal infections (BtIFI) in patients with haematologic malignancies.Methods: BtIFI in patients with & GE; 7 days of prior antifungals were prospectively diagnosed (36 months across 13 Spanish hospitals) according to revised EORTC/MSG definitions.Results: 121 episodes of BtIFI were documented, of which 41 (33.9%) were proven; 53 (43.8%), probable; and 27 (22.3%), possible. The most frequent prior antifungals included posaconazole (32.2%), echinocandins (28.9%) and fluconazole (24.8%)-mainly for primary prophylaxis (81%). The most common haematologic malignancy was acute leukaemia (64.5%), and 59 (48.8%) patients had undergone a hematopoietic stem-cell transplantation. Invasive aspergillosis, principally caused by non-fumigatus Aspergillus, was the most fre-quent BtIFI with 55 (45.5%) episodes recorded, followed by candidemia (23, 19%), mucormycosis (7, 5.8%), other moulds (6, 5%) and other yeasts (5, 4.1%). Azole resistance/non-susceptibility was commonly found. Prior antifungal therapy widely determined BtIFI epidemiology. The most common cause of BtIFI in proven and probable cases was the lack of activity of the prior antifungal (63, 67.0%). At diagnosis, antifungal therapy was mostly changed (90.9%), mainly to liposomal amphotericin-B (48.8%). Overall, 10 0-day mor-tality was 47.1%; BtIFI was either the cause or an essential contributing factor to death in 61.4% of cases.Conclusions: BtIFI are mainly caused by non-fumigatus Aspergillus, non-albicans Candida, Mucorales and other rare species of mould and yeast. Prior antifungals determine the epidemiology of BtIFI. The exceed-ingly high mortality due to BtIFI warrants an aggressive diagnostic approach and early initiation of broad-spectrum antifungals different than those previously used.& COPY; 2023 The Author(s). Published by Elsevier Ltd on behalf of The British Infection Association. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
Note: | Reproducció del document publicat a: https://doi.org/10.1016/j.jinf.2023.05.005 |
It is part of: | Journal of Infection, 2023, vol. 87, num. 1, p. 46-53 |
URI: | http://hdl.handle.net/2445/201926 |
Related resource: | https://doi.org/10.1016/j.jinf.2023.05.005 |
ISSN: | 1532-2742 |
Appears in Collections: | Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL)) |
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