Husain Shahid, Muñoz Patricia, Forrest Graeme, Alexander Barbara D, Somani Jyoti, Brennan Kathleen, Wagener Marilyn M, Singh Nina
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Clin Infect Dis. 2005 Jan 1;40(1):89-99. doi: 10.1086/426445. Epub 2004 Dec 8.
Unique characteristics, impact of therapy with antifungal agents, and outcome of infections with Scedosporium species were assessed in transplant recipients.
The patients comprised a total of 80 transplant recipients with Scedosporium infections, including 13 patients from our institutions (University of Pittsburgh Medical Center [Pittsburgh, PA], University of Maryland [Baltimore], Duke University Medical Center [Durham, NC], Emory University [Atlanta, GA], and Hospital Gregorio Maranon [Madrid, Spain]) and 67 reported in the literature. The transplant recipients were compared with 190 non-transplant recipients with scedosporiosis who were described in the literature.
Overall, 69% of the infections in hematopoietic stem cell transplant (HSCT) recipients and 53% of the infections in organ transplant recipients were disseminated. HSCT recipients, compared with organ transplant recipients, were more likely to have infections caused by Scedosporium prolificans (P=.045), to have an earlier onset of infection (P=.007), to be neutropenic (P<.0001), and to have fungemia (P=.04). Time elapsed from transplantation to Scedosporium infection in transplant recipients has increased in recent years (P=.002). The mortality rate among transplant recipients with scedosporiosis was 58%. In a logistic regression model using amphotericin B as comparison treatment, voriconazole was associated with a trend towards better survival (odds ratio [OR], 10.40; P=.08). Presence of disseminated infection (OR, 0.20; P=.03) predicted lower survival, and receipt of adjunctive surgery as treatment (OR, 5.52; P=.02) independently predicted a better survival in this model.
Scedosporium infections in transplant recipients were associated with a high rate of dissemination and a poor outcome overall. The use of newer triazole agents warrants consideration as a therapeutic modality for these infections.
对移植受者中拟青霉属感染的独特特征、抗真菌药物治疗的影响及感染结局进行了评估。
患者共有80例移植受者发生拟青霉属感染，其中13例来自我们的机构（匹兹堡大学医学中心[宾夕法尼亚州匹兹堡]、马里兰大学[巴尔的摩]、杜克大学医学中心[北卡罗来纳州达勒姆]、埃默里大学[佐治亚州亚特兰大]和格雷戈里奥·马拉尼翁医院[西班牙马德里]），67例来自文献报道。将移植受者与文献中描述的190例非移植性拟青霉病患者进行比较。
总体而言，造血干细胞移植（HSCT）受者中69%的感染和器官移植受者中53%的感染为播散性感染。与器官移植受者相比，HSCT受者更易发生多育拟青霉引起的感染（P = 0.045）、感染发病更早（P = 0.007）、中性粒细胞减少（P < 0.0001）以及发生真菌血症（P = 0.04）。近年来，移植受者从移植到发生拟青霉属感染的时间间隔有所增加（P = 0.002）。拟青霉病移植受者的死亡率为58%。在以两性霉素B作为对照治疗的逻辑回归模型中，伏立康唑与生存改善趋势相关（比值比[OR]，10.40；P = 0.08）。播散性感染的存在（OR，0.20；P = 0.03）预示生存较低，而接受辅助手术作为治疗（OR，5.52；P = 0.02）在该模型中独立预示生存较好。
移植受者中的拟青霉属感染与高播散率及总体不良结局相关。新型三唑类药物的使用值得作为这些感染的一种治疗方式加以考虑。
