Changing epidemiology of invasive mould infections at Czech and Slovak haematological institutions from 2005 to 2017: analysis of the FIND

Czech version

Authors: B. Weinbergerová ¹; T. Kabut ¹; I. Kocmanová ²; L. Drgoňa ³; M. Kouba ⁴; M. Hričinová ⁴; J. Gabzdilová ⁵; T. Guman ⁵; V. Petečuková ⁶; J. Novák ⁶; K. Forsterová ⁷; J. Haber ⁷; B. Žiaková ⁸; E. Bojtárová ⁸; A. Zavřelová ⁹; M. Karas ¹⁰; V. Chrenkova ¹¹; P. Sedláček ¹¹; B. Tkáčiková ¹²; P. Múdrý ¹²; N. Mallátová ¹³; P. Timr ¹³; A. Kolenova ¹⁴; D. Tanušková ¹⁵; J. Horáková ¹⁵; M. Navrátil ¹⁶; J. Chudej ¹⁷; J. Sokol ¹⁷; M. Rolencová ¹; P. Žák ⁹; P. Cetkovský ⁴; J. Mayer ^1,18; Z. Ráčil ^1,18
Authors‘ workplace: Interní hematologická a onkologická klinika LFMU a FN Brno ¹; Oddělení klinické mikrobiologie FN Brno ²; Klinika onkohematológie, NOÚ a LF UK Bratislava ³; Ústav hematologie a krevní transfuze Praha ⁴; Klinika hematológie a onkohematológie, UN LP Košice ⁵; Interní hematologická klinika, FNKV Praha ⁶; I. interní klinika-klinika hematologie, VFN Praha ⁷; Klinika hematológie a transfuziológie, UN Bratislava ⁸; IV. interní hematologická klinika, FN Hradec Králové ⁹; Hematologicko-onkologické oddělení, FN Plzeň ¹⁰; Klinika dětské hematologie a onkologie, 2. LF UK a FN Motol, Praha ¹¹; Klinika dětské onkologie, LFMU a FN Brno ¹²; Dětské oddělení, Nemocnice České Budějovice ¹³; Klinika detskej hematológie a onkológie, DFNsP Bratislava ¹⁴; Transplantačná jednotka kostnej drene, KDHaO, DFNsP Bratislava ¹⁵; Klinika hematoonkologie, FN Ostrava ¹⁶; Klinika hematológie a transfuziológie, JLF a UN Martin ¹⁷; CEITEC – Central European Institute of Technology, Masaryk University Brno ¹⁸
Published in: Transfuze Hematol. dnes,25, 2019, No. 2, p. 186-196.
Category: Original Papers

Overview

Background: Invasive fungal diseases are life-threatening infectious complications affecting haematological patients and their early diagnosis can contribute to improved survival of affected patients. In the last years, the patterns of invasive fungal infections have changed mainly due to the selection pressure of antifungals.

Material and Methods: The aim of our analysis to evaluate retrospectively changes in the epidemiology of invasive aspergillosis, invasive candidiasis and rare mycoses in haematological patients at Czech and Slovak haematological centres from 2005–2017. The observed period was divided into: 2005–2012 (1st period) and 2013–2017 (2nd period). Data entered into FIND – Fungal INfection Database (according to the EORTC/MSG criteria from 2008) was used for the analysis. The total consumption of posaconazole and micafungin was expressed in relative annual consumption per 1000 bed-days.

Results: A total of 349 invasive aspergillosis, 168 invasive candidiasis and 102 rare mycoses (65.7% invasive zygomycosis) were documented. The incidence of aspergillosis increased from 2005 to 2012, with a declining trend since 2013 (the average number of cases per centre in 2005–2012–2017 was: 1.1–3.6–0.7). The incidence of aspergillosis in high risk patients decreased (2005 – 72.7%, 2013 – 42.4%, 2017 – 18.2%). Total consumption of posaconazole has been on the increase since 2005 (rDDD in 2005-2010-2015: 0-831-1043). The total number of invasive candidiasis and rare mycoses remained unchanged over the years. The Candida albicans vs. non-albicans ratio remained unchanged in the 1st and 2nd periods (26.1% vs. 29.1%, p=0.732). There was a significant increase in rare mycoses in breakthrough infections on posaconazole or voriconazole prophylaxis compared to non-breakthrough infections (35.3% vs. 14.4%).

Conclusion: Based on our analysis, we have confirmed a decrease in the incidence of invasive aspergillosis from 2013 after the introduction of routine antifungal prophylaxis with posaconazole in high-risk patients. The ratio of high-risk patients with invasive zygomycosis has also decreased. Patients on posaconazole or voriconazole prophylaxis have changed the spectrum of infections in favour of rare pathogens.

Keywords:

invasive fungal infection – haematological patient – acute leukaemia

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