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


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


Sources

1. Herbrecht R, Bories P, Moulin JC, Ledoux MP, Letscher-Bru V. Risk stratification for invasive aspergillosis in immunocompromised patients. Ann N Y Acad Sci 2012;1272:23–30.

2. Pagano L, Akova M, Dimopoulos G, Herbrecht R, Drgona L, Blijlevens N. Risk assessment and prognostic factors for mould-related diseases in immunocompromised patients. J Antimicrob Chemother 2011;66(Suppl 1):i5–14.

3. Racil Z, Weinbergerova B, Kocmanova I, et al. Invasive aspergillosis in patients with hematological malignancies in the Czech and Slovak republics: Fungal InfectioN Database (FIND) analysis, 2005–2009. Int J Infect Dis 2013;17(2):e101–109.

4. Pagano L, Caira M, Candoni A, et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica 2006;91:1068–1075.

5. Cornely OA, Gachot B, Akan H, et al. Epidemiology and outcome of fungemia in a cancer Cohort of the Infectious Diseases Group (IDG) of the European Organization for Research and Treatment of Cancer (EORTC 65031). Clin Infect Dis 2015;61:324–331.

6. Enoch DA, Yang H, Aliyu SH, Micallef C. The changing epidemiology of invasive fungal infections. MethodsMol Biol 2017;1508:17–65.

7. Tortorano AM, Peman J, Bernhardt H, et al. Epidemiology of candidaemia in Europe: results of 28-month European Confederation of Medical Mycology (ECMM) hospital-based surveillance study. Eur J Clin Microbiol Infect Dis 2004;23:317–322.

8. Wisplinghoff H, Ebbers J, Geurtz L, et al. Nosocomial bloodstream infections due to Candida spp. in the USA: species distribution, clinical features and antifungal susceptibilities. Int J Antimicrob Agents 2014;43:78–81.

9. Haber J, Ráčil Z, Mayer J, Mallátová N, Kouba M, Sedláček P, et al. Léčba invazivní kandidózy – doporučení odborných společností. Transfuze Hematol dnes 2009;15(1):7–16.

10. Kontoyiannis DP, Marr KA, Park BJ, et al. Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001–2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database. Clin Infect Dis 2010;50:1091–1100.

11. Omer AK, Ziakas PD, Anagnostou T, et al. Risk factors for invasive fungal disease after allogeneic hematopoietic stem cell transplantation: a single center experience. Biol Blood Marrow Transplant 2013;19:1190–1196.

12. Girmenia C, Raiola AM, Piciocchi A, et al. Incidence and outcome of invasive fungal diseases after allogeneic stem cell transplantation: a prospective study of the Gruppo Italiano Trapianto Midollo Osseo (GITMO). Biol Blood Marrow Transplant 2014;20:872–880.

13. Ananda-Rajah MR, Cheng A, Morrissey CO, et al. Attributable hospital cost and antifungal treatment of invasive fungal diseases in high-risk hematology patients: an economic modeling approach. Antimicrob Agents Chemother 2011;55:1953–1960.

14. Heimann SM, Vehreschild MJ, Cornely OA, et al. A cost and resource utilization analysis of micafungin bridging for hemato-oncological high-risk patients undergoing allogeneic stem cell transplantation. Eur J Haematol 2015;94:526–531.

15. Lewis RE, Cahyame-Zuniga L, Leventakos K, et al. Epidemiology and sites of involvement of invasive fungal infections in patients with haematological malignancies: a 20–year autopsy study. Mycoses 2013;56:638–645.

16. Cornely OA, Maertens J, Winston DJ, et al. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med 2007;356:348–359.

17. Neoh CF, Snell GI, Kotsimbos T, et al. Antifungal prophylaxis in lung transplantation - a world-wide survey. Am J Transplant 2011;11:361–366.

18. Ullmann AJ, Lipton JH, Vesole DH, et al. Posaconazole or fluconazole for prophylaxis in severe graft-versus-host disease. N Engl J Med 2007;356:335–347.

19. Verweij PE, Chowdhary A, Melchers WJ, Meis JF. Azole resistance in Aspergillus fumigatus: can we retain the clinical use of mold-active antifungal azoles? Clin Infect Dis 2016;62:362–368.

20. van der Linden JW, Arendrup MC, Melchers WJ, et al. Azole resistance of Aspergillus fumigatus in immunocompromised patients with invasive aspergillosis. Emerg Infect Dis 2016;22:158–159.

21. Wang E, Farmakiotis D, Yang D, et al. The ever-evolving landscape of candidaemia in patients with acute leukaemia: non-susceptibility to caspofungin and multidrug resistance are associated with increased mortality. J Antimicrob Chemother 2015;70:2362–2368.

22. Auberger J, Lass-Flörl C, Aigner M, et al. Invasive fungal breakthrough infections, fungal colonization and emergence of resistant strains in high-risk patients receiving antifungal prophylaxis with posaconazole: real-life data from a single-centre institutional retrospective observational study. J Antimicrob Chemother 2012;67:2268–2273.

23. Biehl LM, Vehreschild JJ, Liss B, et al. A cohort study on breakthrough invasive fungal infections in high-risk patients receiving antifungal prophylaxis. J Antimicrob Chemother 2016;71:2634–2641.

24. Corzo-León DE, Satlin MJ, Soave R, et al. Epidemiology and outcomes of invasive fungal infections in allogeneic haematopoietic stem cell transplant recipients in the era of antifungal prophylaxis: a single-centre study with focus on emerging pathogens. Mycoses 2015;58:325–336.

25. Lerolle N, Raffoux E, Socie G, et al. Breakthrough invasive fungal disease in patients receiving posaconazole primary prophylaxis: a 4 -year study. Clin Microbiol Infect 2014;20:952–959.

26. Lamoth F, Chung SJ, Damonti L, et al. Changing epidemiology of invasive mold infections in patients receiving azole prophylaxis. Clin Infect Dis 2017;64 (11):1619–1621.

27. De Pauw B, Walsh TJ, Donnelly JP, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008;46:1813–1821.

28. Segal BH, Herbrecht R, Stevens DA, et al. Defining responses to therapy and study outcomes in clinical trials of invasive fungal diseases: Mycoses Study Group and European Organization for Research and Treatment of Cancer consensus criteria. Clin Infect Dis 2008;47(5):674–683.

29. Chamilos G, Luna M, Lewis RE, et al. Invasive fungal infections in patients with hematologic malignancies in a tertiary care cancer center: an autopsy study over a 15-year period (1989–2003). Haematologica 2006;91:986–989.

30. Ráčil Z, Mayer J, Kocmanová I, et al. Léčba invazivní aspergilózy – doporučení odborných společností. Transfuze Hematol dnes 2009;15(1):17–24.

31. Gabzdilová J, Tóthová E, Guman T, Raffač Š, Jarčuška P. Mykotické komplikácie po autológnej transplantácii krvotvorných buniek u pacientov s mnohopočetným myelómom. Transfuze Hematol dnes 2015;21(1):24–29.

32. Haber J, Ráčil Z. Přístupy k antimykotické terapii: od profylaxe k léčbě. Transfuze Hematol dnes 2013;19(1):39–43.

33. Weinbergerova B, Kocmanova I, Racil Z, Mayer J. Serological approaches. Methods Mol Biol 2017;1508:209–221.

34. Čerňan M, Szotkowski T, Kolář M, Hubáček J, Faber E. Infekčné komplikácie behom indukčnej liečby akútnej myeloidnej leukemie bez použitia antibiotickej profylaxie. Transfuze Hematol dnes 2015;21(1):14–23.

35. Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 2008;46:327–360.

36. Maertens J, Marchetti O, Herbrecht R, et al. European guidelines for antifungal management in leukemia and hematopoietic stem cell transplant recipients: summary of the ECIL 3-2009 update. Bone Marrow Transplant 2011;46:709–718.

37. Cornely OA, Böhme A, Buchheidt D, et al. Primary prophylaxis of invasive fungal infections in patients with hematologic malignancies: recommendations of the Infectious Diseases Working Party of the German Society for Haematology and Oncology. Haematologica 2009;94:113–122.

38. Caira M, Candoni A, Verga L, et al. SEIFEM group: Prechemotherapy risk factors for invasive fungal diseases: prospective analysis of 1,192 patients with newly diagnosed acute myeloid leukemia (SEIFEM 2010- a multicenter study). Haematologica 2015;100:284–292.

39. Kabut T, Folber F, Šálek C, et al. Primární antimykotická profylaxe micafunginem, v dávce 50 mg na den, u dospělých pacientů během indukční chemoterapie akutní lymfoblastické leukemie (ALL): hodnocení z pohledu běžné klinické praxe. Transfuze Hematol dnes 2016;22(S1):133–135.

40. Wingard JR, Merz WG, Rinaldi MG, et al. Increase in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole. N Engl J Med 1991;325:1274–1277.

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