Gutiérrez-Villanueva Andrea, Diego-Yagüe Itziar, Gutiérrez-Martín Isabel, García-Prieto Sonia, Gutiérrez-Abreu Edith, Fernández-Guitián Román, Castilla-Martínez Isabel, Bermejo-Moreno Naomi, Miguel-Ontañon Nuria, Calderón-Parra Jorge, Callejas-Díaz Alejandro, Díaz-de Santiago Alberto, de la Fuente-Moral Sara, Múñez-Rubio Elena, García-Masedo Sarela, Sánchez-Romero Isabel, Ramos-Martínez Antonio, Fernández-Cruz Ana
Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, C/Joaquín Rodrigo nº 2, 28222, Majadahonda, Madrid, Spain.
Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, Madrid, Spain.
Ann Clin Microbiol Antimicrob. 2025 Apr 25;24(1):28. doi: 10.1186/s12941-025-00794-8.
INTRODUCTION: In times of mold active prophylaxis, invasive aspergillosis (IA) epidemiology is evolving. Presentation in non-neutropenic may differ from neutropenic. We investigated the cases of IA in our center with a focus on differences between neutropenic and non-neutropenic, and analyzed the impact of cryptic and non-fumigatus Aspergillus species. METHODS: Retrospective observational study including all adult patients admitted to the Puerta de Hierro-Majadahonda Hospital between January 2018 and April 2024 with IA. RESULTS: 112 IA were identified. Only 11 (9.8%) had neutropenia as risk factor for IA. Most frequent risk factors were corticosteroids (77.2%), SOT (46.5%), SARS-CoV2 (29.7%) and CMV replication (28.7%). 89.3% were pulmonary IA with 6 cases (5.4%) of disseminated infection. A. fumigatus was the most frequent species 48 (51.6%). 13 cases (14%) were caused by cryptic Aspergillus spp. Non-neutropenic patients, compared to neutropenic patients, were more likely to have positive fungal cultures (83.2% versus 54.5%, p = 0.023[NS]), and not to present a halo sign (7.4% versus 45.5%, p = 0.003 [NS]). In addition, in non-neutropenic patients, compared to neutropenic patients, there was a trend towards a greater probability of positive GM from BAL (81.3% versus 66.7%, p = 0.304) and a trend towards a lower probability of positive serum GM (25.7% versus 45.5%, p = 0.137). 41/112 (36.6%) cases presented breakthrough IFI and in 51.2%, (21/41 cases), the isolate was resistant to the prior antifungal. One presented A. fumigatus with the TR34-L98H mutation. CONCLUSION: Risk factors different than neutropenia are currently the most common in IA. The clinical presentation in non-neutropenic patients differs from neutropenic. Resistance to antifungals is emerging especially in breakthrough IA.
引言：在进行霉菌积极预防的时期，侵袭性曲霉病（IA）的流行病学正在演变。非中性粒细胞减少患者的表现可能与中性粒细胞减少患者不同。我们调查了本中心的IA病例，重点关注中性粒细胞减少和非中性粒细胞减少患者之间的差异，并分析了隐匿性和非烟曲霉属菌种的影响。 方法：回顾性观察研究，纳入2018年1月至2024年4月期间入住铁之门 - 马亚达洪达医院的所有成年IA患者。 结果：共确诊112例IA。只有11例（9.8%）有中性粒细胞减少作为IA的危险因素。最常见的危险因素是皮质类固醇（77.2%）、实体器官移植（SOT，46.5%）、严重急性呼吸综合征冠状病毒2（SARS-CoV2，29.7%）和巨细胞病毒（CMV）复制（28.7%）。89.3%为肺部IA，6例（5.4%）为播散性感染。烟曲霉是最常见的菌种，有48例（51.6%）。13例（14%）由隐匿性曲霉属菌种引起。与中性粒细胞减少患者相比，非中性粒细胞减少患者更有可能真菌培养呈阳性（83.2%对54.5%，p = 0.023[无统计学意义]），且不太可能出现晕征（7.4%对45.5%，p = 0.003[无统计学意义]）。此外，与中性粒细胞减少患者相比，非中性粒细胞减少患者支气管肺泡灌洗（BAL）中半乳甘露聚糖（GM）检测呈阳性的概率有升高趋势（81.3%对66.7%，p = 0.304），血清GM检测呈阳性的概率有降低趋势（25.7%对45.5%，p = 0.137）。41/112（36.6%）例出现突破性侵袭性真菌感染（IFI），其中51.2%（21/41例）的分离株对先前使用的抗真菌药物耐药。有1例烟曲霉带有TR34 - L98H突变。 结论：目前IA中最常见的危险因素不是中性粒细胞减少。非中性粒细胞减少患者的临床表现与中性粒细胞减少患者不同。抗真菌药物耐药性正在出现，尤其是在突破性IA中。
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