Kuster Sabine, Stampf Susanne, Gerber Bernhard, Baettig Veronika, Weisser Maja, Gerull Sabine, Medinger Michael, Passweg Jakob, Schanz Urs, Garzoni Christian, Berger Christoph, Chalandon Yves, Mueller Nicolas J, van Delden Christian, Neofytos Dionysios, Khanna Nina
Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Basel, Basel, Switzerland.
Clinic for Transplantation Immunology and Nephrology, University Hospital of Basel, Basel, Switzerland.
Transpl Infect Dis. 2018 Dec;20(6):e12981. doi: 10.1111/tid.12981. Epub 2018 Sep 4.
Contemporary, comprehensive data on epidemiology and outcomes of invasive fungal disease (IFD) including breakthrough IFD among allogeneic hematopoietic stem cell transplantation (HSCT) recipients are scarce. We included 479 allogeneic HSCT recipients with 10 invasive candidiasis (IC) and 31 probable/proven invasive mold disease (IMD) from the Swiss Transplant Cohort Study from 01.2009 to 08.2013. Overall cumulative incidence was 2.3% for IC and 8.5% for probable/proven IMI: 6% for invasive aspergillosis (IA) and 2.5% for non-AspergillusIMI. Among 41 IFD, 46% IFD were breakthrough, with an overall incidence of 4.6%, more frequently caused by other-than-Aspergillus fumigatus molds than primary IFD (47.6% (10/21) vs 13% (3/23), P = 0.04). Twelve-week mortality among patients with IC was 20% and 58.6% for probable/proven IMD (60% IA and 54.6% non-Aspergillus). Our results reveal that breakthrough IFD represent a marked burden of probable/proven IFD postallogeneic HSCT and mortality remains above 50% in patients with probable/proven IMD, underscoring the ongoing challenges to prevent and treat IFD in these patients.
目前，关于侵袭性真菌病（IFD）的流行病学及转归，包括异基因造血干细胞移植（HSCT）受者中突破性IFD的全面数据较为匮乏。我们纳入了瑞士移植队列研究中2009年1月至2013年8月期间的479例异基因HSCT受者，其中10例发生侵袭性念珠菌病（IC），31例发生疑似/确诊侵袭性霉菌病（IMD）。IC的总体累积发病率为2.3%，疑似/确诊IMI为8.5%：侵袭性曲霉病（IA）为6%，非曲霉菌IMI为2.5%。在41例IFD中，46%为突破性IFD，总体发病率为4.6%，非烟曲霉霉菌引起的突破性IFD比原发性IFD更常见（47.6%（10/21）对13%（3/23），P = 0.04）。IC患者的12周死亡率为20%，疑似/确诊IMD患者为58.6%（IA为60%，非曲霉菌为54.6%）。我们的结果显示，突破性IFD是异基因HSCT后疑似/确诊IFD的一个显著负担，疑似/确诊IMD患者的死亡率仍高于50%，这凸显了在这些患者中预防和治疗IFD面临的持续挑战。
