2001-2006 年造血干细胞移植受者侵袭性真菌感染的前瞻性监测：移植相关感染监测网络（TRANSNET）数据库概述。

Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database.

机构信息

The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

出版信息

Clin Infect Dis. 2010 Apr 15;50(8):1091-100. doi: 10.1086/651263.

DOI:10.1086/651263

PMID:20218877

Abstract

BACKGROUND

The incidence and epidemiology of invasive fungal infections (IFIs), a leading cause of death among hematopoeitic stem cell transplant (HSCT) recipients, are derived mainly from single-institution retrospective studies.

METHODS

The Transplant Associated Infections Surveillance Network, a network of 23 US transplant centers, prospectively enrolled HSCT recipients with proven and probable IFIs occurring between March 2001 and March 2006. We collected denominator data on all HSCTs preformed at each site and clinical, diagnostic, and outcome information for each IFI case. To estimate trends in IFI, we calculated the 12-month cumulative incidence among 9 sequential subcohorts.

RESULTS

We identified 983 IFIs among 875 HSCT recipients. The median age of the patients was 49 years; 60% were male. Invasive aspergillosis (43%), invasive candidiasis (28%), and zygomycosis (8%) were the most common IFIs. Fifty-nine percent and 61% of IFIs were recognized within 60 days of neutropenia and graft-versus-host disease, respectively. Median onset of candidiasis and aspergillosis after HSCT was 61 days and 99 days, respectively. Within a cohort of 16,200 HSCT recipients who received their first transplants between March 2001 and September 2005 and were followed up through March 2006, we identified 718 IFIs in 639 persons. Twelve-month cumulative incidences, based on the first IFI, were 7.7 cases per 100 transplants for matched unrelated allogeneic, 8.1 cases per 100 transplants for mismatched-related allogeneic, 5.8 cases per 100 transplants for matched-related allogeneic, and 1.2 cases per 100 transplants for autologous HSCT.

CONCLUSIONS

In this national prospective surveillance study of IFIs in HSCT recipients, the cumulative incidence was highest for aspergillosis, followed by candidiasis. Understanding the epidemiologic trends and burden of IFIs may lead to improved management strategies and study design.

摘要

背景

造血干细胞移植（HSCT）受者侵袭性真菌感染（IFI）的发病率和流行病学主要来源于单机构回顾性研究。

方法

移植相关感染监测网络（Transplant Associated Infections Surveillance Network）是由 23 个美国移植中心组成的网络，前瞻性地招募了 2001 年 3 月至 2006 年 3 月期间发生确诊和疑似 IFI 的 HSCT 受者。我们收集了每个中心进行的所有 HSCT 的分母数据以及每个 IFI 病例的临床、诊断和结局信息。为了估计 IFI 的趋势，我们计算了 9 个连续亚组中 12 个月的累积发生率。

结果

我们在 875 例 HSCT 受者中发现了 983 例 IFI。患者的中位年龄为 49 岁；60%为男性。侵袭性曲霉病（43%）、侵袭性念珠菌病（28%）和接合菌病（8%）是最常见的 IFI。IFI 分别有 59%和 61%在中性粒细胞减少和移植物抗宿主病发生后 60 天内被识别。念珠菌病和曲霉病在 HSCT 后的中位发病时间分别为 61 天和 99 天。在 2001 年 3 月至 2005 年 9 月期间接受首次移植并随访至 2006 年 3 月的 16200 例 HSCT 受者队列中，我们在 639 名患者中发现了 718 例 IFI。基于首次 IFI，匹配无关异体、错配相关异体、匹配相关异体和自体 HSCT 的 12 个月累积发生率分别为每 100 例移植 7.7 例、8.1 例、5.8 例和 1.2 例。