Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Infectious Diseases Service at the Doherty Institute, Melbourne, Australia.
Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia; Department of Infectious Diseases and Microbiology, Liverpool Hospital, Sydney, Australia.
Clin Microbiol Infect. 2015 May;21(5):490.e1-10. doi: 10.1016/j.cmi.2014.12.021. Epub 2015 Jan 14.
The epidemiology of invasive fungal disease (IFD) due to filamentous fungi other than Aspergillus may be changing. We analysed clinical, microbiological and outcome data in Australian patients to determine the predisposing factors and identify determinants of mortality. Proven and probable non-Aspergillus mould infections (defined according to modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria) from 2004 to 2012 were evaluated in a multicentre study. Variables associated with infection and mortality were determined. Of 162 episodes of non-Aspergillus IFD, 145 (89.5%) were proven infections and 17 (10.5%) were probable infections. The pathogens included 29 fungal species/species complexes; mucormycetes (45.7%) and Scedosporium species (33.3%) were most common. The commonest comorbidities were haematological malignancies (HMs) (46.3%) diabetes mellitus (23.5%), and chronic pulmonary disease (16%); antecedent trauma was present in 21% of cases. Twenty-five (15.4%) patients had no immunocompromised status or comorbidity, and were more likely to have acquired infection following major trauma (p <0.01); 61 (37.7%) of cases affected patients without HMs or transplantation. Antifungal therapy was administered to 93.2% of patients (median 68 days, interquartile range 19-275), and adjunctive surgery was performed in 58.6%. The all-cause 90-day mortality was 44.4%; HMs and intensive-care admission were the strongest predictors of death (both p <0.001). Survival varied by fungal group, with the risk of death being significantly lower in patients with dematiaceous mould infections than in patients with other non-Aspergillus mould infections. Non-Aspergillus IFD affected diverse patient groups, including non-immunocompromised hosts and those outside traditional risk groups; therefore, definitions of IFD in these patients are required. Given the high mortality, increased recognition of infections and accurate identification of the causative agent are required.
除曲霉属丝状真菌以外的侵袭性真菌病（IFD）的流行病学可能正在发生变化。我们分析了澳大利亚患者的临床、微生物学和结局数据，以确定易患因素和识别死亡率的决定因素。根据改良的欧洲癌症研究与治疗组织/霉菌病研究组标准，对 2004 年至 2012 年间的多中心研究中的确诊和可能的非曲霉属霉菌感染进行了评估。确定了与感染和死亡率相关的变量。162 例非曲霉 IFD 中，145 例（89.5%）为确诊感染，17 例（10.5%）为可能感染。病原体包括 29 种真菌种/种复合体；毛霉（45.7%）和枝孢霉（33.3%）最常见。最常见的合并症是血液系统恶性肿瘤（HM）（46.3%）、糖尿病（23.5%）和慢性肺部疾病（16%）；21%的病例存在既往创伤史。25 例（15.4%）患者无免疫抑制状态或合并症，且更有可能因重大创伤而发生感染（p<0.01）；61 例（37.7%）病例影响无 HM 或移植的患者。93.2%的患者接受了抗真菌治疗（中位数 68 天，四分位距 19-275 天），58.6%的患者进行了辅助手术。全因 90 天死亡率为 44.4%；HM 和重症监护病房入院是死亡的最强预测因素（均 p<0.001）。生存率因真菌群而异，暗色真菌感染患者的死亡风险明显低于其他非曲霉属霉菌感染患者。非曲霉 IFD 影响了不同的患者群体，包括非免疫抑制宿主和传统风险群体以外的患者；因此，这些患者需要有 IFD 的定义。鉴于高死亡率，需要提高对感染的认识并准确识别病原体。
