血液学中Magnusiomyces（Saprochaete）感染的临床特征及预后因素。SEIFEM/Fungiscope多中心研究。

Clinical features and prognostic factors of Magnusiomyces (Saprochaete) infections in haematology. A multicentre study of SEIFEM/Fungiscope.

作者信息

Del Principe Maria Ilaria, Seidel Danila, Criscuolo Marianna, Dargenio Michelina, Rácil Zdenek, Piedimonte Monica, Marchesi Francesco, Nadali Gianpaolo, Koehler Philipp, Fracchiolla Nicola, Cattaneo Chiara, Klimko Nikolai, Spolzino Angelica, Yilmaz Karapinar Deniz, Demiraslan Hayati, Duarte Rafael F, Demeter Judit, Stanzani Marta, Melillo Lorella Maria Antonia, Basilico Claudia Maria, Cesaro Simone, Paterno Giovangiacinto, Califano Catello, Delia Mario, Buzzatti Elisa, Busca Alessandro, Alakel Nael, Arsenijevi'c Valentina Arsi'c, Camus Vincent, Falces-Romero Iker, Itzhak Levy, Kouba Michal, Martino Rodrigo, Sedlacek Petr, Weinbergerová Barbora, Cornely Oliver A, Pagano Livio

机构信息

Dipartimento di Biomedicina e Prevenzione, Università degli studi di Roma "Tor Vergata", Roma, Italy.

Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

出版信息

Mycoses. 2023 Jan;66(1):35-46. doi: 10.1111/myc.13524. Epub 2022 Sep 19.

DOI:10.1111/myc.13524

PMID:36064299

Abstract

BACKGROUND

Our multicentre study aims to identify baseline factors and provide guidance for therapeutic decisions regarding Magnusiomyces-associated infections, an emerging threat in patients with haematological malignancies.

METHODS

HM patients with proven (Magnusiomyces capitatus) M. capitatus or (Magnusiomyces clavatus) M. clavatus (formerly Saprochaete capitata and Saprochaete clavata) infection diagnosed between January 2010 and December 2020 were recorded from the SEIFEM (Sorveglianza Epidemiologica Infezioni nelle Emopatie) group and FungiScope (Global Emerging Fungal Infection Registry). Cases of Magnusiomyces fungemia were compared with candidemia.

RESULTS

Among 90 Magnusiomyces cases (60 [66%] M. capitatus and 30 (34%) M. clavatus), median age was 50 years (range 2-78), 46 patients (51%) were female and 67 (74%) had acute leukaemia. Thirty-six (40%) of Magnusiomyces-associated infections occurred during antifungal prophylaxis, mainly with posaconazole (n = 13, 36%) and echinocandins (n = 12, 34%). Instead, the candidemia rarely occurred during prophylaxis (p < .0001). First-line antifungal therapy with azoles, alone or in combination, was associated with improved response compared to other antifungals (p = .001). Overall day-30 mortality rate was 43%. Factors associated with higher mortality rates were septic shock (HR 2.696, 95% CI 1.396-5.204, p = .003), corticosteroid treatment longer than 14 days (HR 2.245, 95% CI 1.151-4.376, p = .018) and lack of neutrophil recovery (HR 3.997, 95% CI 2.102-7.601, p < .001). The latter was independently associated with poor outcome (HR 2.495, 95% CI 1.192-5.222, p = .015).

CONCLUSIONS

Magnusiomyces-associated infections are often breakthrough infections. Effective treatment regimens of these infections remain to be determined, but neutrophil recovery appears to play an important role in the favourable outcome.

摘要

背景

我们的多中心研究旨在确定基线因素，并为血液系统恶性肿瘤患者中出现的一种新威胁——与Magnusiomyces相关的感染的治疗决策提供指导。

方法

从SEIFEM（血液系统疾病感染流行病学监测）组和FungiScope（全球新兴真菌感染登记处）记录2010年1月至2020年12月期间确诊的患有头状Magnusiomyces（Magnusiomyces capitatus）或棒状Magnusiomyces（Magnusiomyces clavatus）（以前称为头状腐质霉和棒状腐质霉）感染的血液系统恶性肿瘤患者。将Magnusiomyces真菌血症病例与念珠菌血症病例进行比较。

结果

在90例Magnusiomyces病例中（60例[66%]为头状Magnusiomyces，30例[34%]为棒状Magnusiomyces），中位年龄为50岁（范围2 - 78岁），46例患者（51%）为女性，67例（74%）患有急性白血病。36例（40%）与Magnusiomyces相关的感染发生在抗真菌预防期间，主要使用泊沙康唑（n = 13，36%）和棘白菌素（n = 12，34%）。相反，念珠菌血症很少在预防期间发生（p <.0001）。与其他抗真菌药物相比，单独或联合使用唑类进行一线抗真菌治疗与更好的反应相关（p = .001）。总体30天死亡率为43%。与较高死亡率相关的因素包括感染性休克（HR 2.696，95%CI 1.396 - 5.204，p = .003）、皮质类固醇治疗超过14天（HR 2.245，95%CI 1.151 - 4.376，p = .018）和中性粒细胞未恢复（HR 3.997，95%CI 2.102 - 7.601，p <.001）。后者与不良预后独立相关（HR 2.495，95%CI 1.192 - 5.222，p = .015）。