Hachem Ray, Gomes Marisa Zenaide Ribeiro, El Helou Gilbert, El Zakhem Aline, Kassis Christelle, Ramos Elizabeth, Jiang Ying, Chaftari Anne-Marie, Raad Issam I
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
J Antimicrob Chemother. 2014 Nov;69(11):3148-55. doi: 10.1093/jac/dku241. Epub 2014 Jul 8.
Invasive aspergillosis (IA) caused by Aspergillus terreus is a significant cause of morbidity and mortality in patients with haematological malignancy (HM). Very few data are available in this patient population to differentiate IA patients with A. terreus from those with non-terreus species of Aspergillus to compare outcomes. We retrospectively investigated 513 HM patients who were treated for either definite or probable IA between June 1993 and August 2012 in a cancer centre.
We compared baseline characteristics, antifungal therapies and outcomes between patients infected with A. terreus (n = 96, 18.7%) and those infected with non-terreus Aspergillus species (n = 335, 65.3%). Eighty-one patients with mixed or unspecified Aspergillus infections were excluded.
Breakthrough infections occurred more frequently in the A. terreus group (91% versus 77%, P = 0.009). A. terreus infection was associated with a lower rate of final response to antifungal therapy (21% versus 38%, P = 0.0015) and a higher rate of IA-associated mortality (51% versus 30%, P < 0.001). Multivariate analyses showed that these associations were independent of patients' clinical characteristics and the antifungal regimens they received. Factors independently associated with final response included treatment with azoles (OR 3.1, 95% CI 1.9-5.0, P < 0.0001) and Aspergillus species (A. terreus versus non-terreus Aspergillus species) (OR 0.5, 95% CI 0.3-0.98, P = 0.043). Additionally, Aspergillus species and treatment with azoles were independently associated with IA-associated mortality.
A. terreus IA in HM patients was associated with worse outcome than IA caused by non-terreus Aspergillus species. Poor prognosis in patients with invasive A. terreus infections is independent of anti-Aspergillus azole-based treatment.
土曲霉引起的侵袭性曲霉病（IA）是血液系统恶性肿瘤（HM）患者发病和死亡的重要原因。在该患者群体中，几乎没有数据可用于区分感染土曲霉的IA患者与感染非土曲霉属曲霉的患者，以比较预后情况。我们回顾性调查了1993年6月至2012年8月期间在一家癌症中心接受确诊或疑似IA治疗的513例HM患者。
我们比较了感染土曲霉的患者（n = 96，18.7%）和感染非土曲霉属曲霉的患者（n = 335，65.3%）的基线特征、抗真菌治疗及预后。81例混合或未明确的曲霉感染患者被排除。
突破性感染在土曲霉组中更频繁发生（91%对77%，P = 0.009）。土曲霉感染与抗真菌治疗的最终缓解率较低相关（21%对38%，P = 0.0015），且与IA相关死亡率较高相关（51%对30%，P < 0.001）。多因素分析表明，这些关联独立于患者的临床特征及其接受的抗真菌治疗方案。与最终缓解独立相关的因素包括使用唑类药物治疗（比值比3.1，95%置信区间1.9 - 5.0，P < 0.0001）和曲霉种类（土曲霉对非土曲霉属曲霉）（比值比0.5，95%置信区间0.3 - 0.98，P = 0.043）。此外，曲霉种类和唑类药物治疗与IA相关死亡率独立相关。
HM患者中的土曲霉IA与非土曲霉属曲霉引起的IA相比，预后更差。侵袭性土曲霉感染患者的预后不良独立于基于抗曲霉唑类的治疗。
