Institut Pasteur, Centre National de Référence Mycologie et Antifongiques, Unité de Mycologie Moléculaire, Paris CNRS URA3012, Paris, France.
Clin Microbiol Infect. 2011 Dec;17(12):1882-9. doi: 10.1111/j.1469-0691.2011.03548.x. Epub 2011 Jun 10.
A prospective (2005-2007) hospital-based multicentre surveillance of EORTC/MSG-proven or probable invasive aspergillosis (IA) cases whatever the underlying diseases was implemented in 12 French academic hospitals. Admissions per hospital and transplantation procedures were obtained. Cox regression models were used to determine risk factors associated with the 12-week overall mortality. With 424 case-patients included, the median incidence/hospital was 0.271/10(3) admissions (range 0.072-0.910) without significant alteration of incidence and seasonality over time. Among the 393 adults (62% men, 56 years (16-84 years)), 15% had proven IA, 78% haematological conditions, and 92.9% had lung involvement. Acute leukaemia (34.6%) and allogeneic stem cell transplantation (21.4%) were major host factors, together with chronic lymphoproliferative disorders (21.6%), which emerged as a new high-risk group. The other risk host factors consisted of solid organ transplantation (8.7%), solid tumours (4.3%), systemic inflammatory diseases (4.6%) and chronic respiratory diseases (2.3%). Serum galactomannan tests were more often positive (≥69%) for acute leukaemia and allogeneic stem cell transplantation than for the others (<42%; p <10(-3)). When positive (n = 245), cultures mainly yielded Aspergillus fumigatus (79.7%). First-line antifungal therapy consisted of voriconazole, caspofungin, lipid formulations of amphotericin, or any combination therapy (52%, 14%, 8% and 19.9%, respectively). Twelve-week overall mortality was 44.8% (95% CI, 39.8-50.0); it was 41% when first-line therapy included voriconazole and 60% otherwise (p <0.001). Independent factors for 12-week mortality were older age, positivity for both culture and galactomannan and central nervous system or pleural involvement, while any strategy containing voriconazole was protective.
一项前瞻性（2005-2007 年）基于医院的多中心监测，针对 EORTC/MSG 确诊或疑似侵袭性曲霉菌病（IA）病例，无论基础疾病如何，在 12 家法国学术医院进行。获得每个医院的入院人数和移植手术。使用 Cox 回归模型确定与 12 周总死亡率相关的危险因素。纳入 424 例病例患者，中位数发病率/医院为 0.271/10(3)入院（范围 0.072-0.910），发病率和季节性随时间无明显变化。在 393 名成人（62%为男性，56 岁（16-84 岁））中，15%为确诊的 IA，78%为血液系统疾病，92.9%有肺部受累。急性白血病（34.6%）和异基因干细胞移植（21.4%）是主要的宿主因素，与慢性淋巴增生性疾病（21.6%）一起，成为新的高危组。其他宿主危险因素包括实体器官移植（8.7%）、实体肿瘤（4.3%）、全身性炎症性疾病（4.6%）和慢性呼吸道疾病（2.3%）。血清半乳甘露聚糖检测对急性白血病和异基因干细胞移植的阳性率（≥69%）高于其他疾病（<42%；p<10(-3)）。阳性时（n=245），培养物主要产生烟曲霉（79.7%）。一线抗真菌治疗包括伏立康唑、卡泊芬净、两性霉素脂质体或任何联合治疗（分别为 52%、14%、8%和 19.9%）。12 周总死亡率为 44.8%（95%CI，39.8-50.0）；一线治疗包括伏立康唑时为 41%，否则为 60%（p<0.001）。12 周死亡率的独立因素是年龄较大、培养和半乳甘露聚糖均阳性以及中枢神经系统或胸膜受累，而包含伏立康唑的任何策略均具有保护作用。
