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Breakthrough invasive fungal infection among patients with haematologic malignancies: a national, prospective, and multicentre study

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 ? 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 frequent 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, 100-day mortality 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 exceedingly high mortality due to BtIFI warrants an aggressive diagnostic approach and early initiation of broad-spectrum antifungals different than those previously used.

 Fuente: Journal of Infection, 2023, 87(1), 46-53

 Editorial: Elsevier

 Año de publicación: 2023

 Nº de páginas: 8

 Tipo de publicación: Artículo de Revista

 DOI: 10.1016/j.jinf.2023.05.005

 ISSN: 0163-4453

 Url de la publicación: https://doi.org/10.1016/j.jinf.2023.05.005

Autoría

PUERTA-ALCALDE, PEDRO

MONZÓ-GALLO, PATRICIA

AGUILAR-GUISADO, MANUELA

RAMOS, JUAN CARLOS

LAPORTE-AMARGÓS, JÚLIA

MACHADO, MARINA

MARTIN-DAVILA, PILAR

FRANCH-SARTO, MIREIA

SÁNCHEZ-ROMERO, ISABEL

BADIOLA, JON

GÓMEZ, LUCIA

RUIZ-CAMPS, ISABEL

VÁZQUEZ, LOURDES

CHUMBITA, MARIANA

MARCO, FRANCESC

SORIANO, ALEX

GONZÁLEZ, PEDRO

FERNÁNDEZ-CRUZ, ANA

BATLLE, MONTSERRAT