Invasive aspergillosis in adult patients in Australia and New Zealand: 2017-2020.

Autor:	Tio SY; Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.; National Centre for Infections in Cancer, Melbourne, Australia.; Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia.; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia., Chen SC; Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia.; School of Medicine, University of Sydney, Australia., Hamilton K; Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia., Heath CH; Department of Microbiology, PathWest Laboratory Medicine, Murdoch, Western Australia, Australia.; Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.; Department of Medicine, University of Western Australia, Crawley, Western Australia, Australia., Pradhan A; Prince of Wales Hospital, Southeast Sydney LHD, NSW Health Pathology, Australia.; School of Medicine, University of Sydney, Australia., Morris AJ; Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand., Korman TM; Monash University and Monash Health, Clayton, Victoria, Australia., Morrissey O; Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia., Halliday CL; Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia.; School of Medicine, University of Sydney, Australia., Kidd S; National Mycology Reference Centre, Microbiology & Infectious Diseases, SA Pathology, Adelaide, South Australia, Australia., Spelman T; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia.; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden., Brell N; Prince of Wales Hospital, Southeast Sydney LHD, NSW Health Pathology, Australia.; University of New South Wales, Australia., McMullan B; Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Australia.; School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Australia., Clark JE; Infection Management Service, Queensland Children's Hospital, Children's Health Queensland, Brisbane 4101, Australia.; School of Clinical Medicine, CHQCU, University of Queensland, Australia., Mitsakos K; Department of Infectious Disease and Microbiology, Royal North Shore Hospital, Sydney, Australia., Hardiman RP; Department of Infectious Disease and Microbiology, Royal North Shore Hospital, Sydney, Australia., Williams P; Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Australia.; School of Public Health, Faculty of Medicine, The University of Sydney, Australia., Campbell AJ; Department of Infectious Diseases, Perth Children's Hospital, Western Australia, Australia.; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Western Australia, Australia., Beardsley J; University of Sydney Infectious Disease Institute, Australia.; Westmead Hospital, Western Sydney LHD, NSW Health, Australia.; Westmead Institute for Medical Research, Australia., Van Hal S; School of Medicine, University of Sydney, Australia.; Department of Infectious Diseases and Microbiology Royal Prince Alfred Hospital, Australia., Yong MK; Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.; National Centre for Infections in Cancer, Melbourne, Australia.; Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia.; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia., Worth LJ; Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.; National Centre for Infections in Cancer, Melbourne, Australia.; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia., Slavin MA; Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.; National Centre for Infections in Cancer, Melbourne, Australia.; Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia.; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia.
Jazyk:	angličtina
Zdroj:	The Lancet regional health. Western Pacific [Lancet Reg Health West Pac] 2023 Sep 04; Vol. 40, pp. 100888. Date of Electronic Publication: 2023 Sep 04 (Print Publication: 2023).
DOI:	10.1016/j.lanwpc.2023.100888
Abstrakt:	Background: New and emerging risks for invasive aspergillosis (IA) bring the need for contemporary analyses of the epidemiology and outcomes of IA, in order to improve clinical practice. Methods: The study was a retrospective, multicenter, cohort design of proven and probable IA in adults from 10 Australasian tertiary centres (January 2017-December 2020). Descriptive analyses were used to report patients' demographics, predisposing factors, mycological characteristics, diagnosis and management. Accelerated failure-time model was employed to determine factor(s) associated with 90-day all-cause mortality (ACM). Findings: Of 382 IA episodes, 221 (in 221 patients) fulfilled inclusion criteria - 53 proven and 168 probable IA. Median patient age was 61 years (IQR 51-69). Patients with haematologic malignancies (HM) comprised 49.8% of cases. Fifteen patients (6.8%) had no pre-specified immunosuppression and eleven patients (5.0%) had no documented comorbidity. Only 30% of patients had neutropenia. Of 170 isolates identified, 40 (23.5%) were identified as non- Aspergillus fumigatus species complex. Azole-resistance was present in 3/46 (6.5%) of A. fumigatus sensu stricto isolates. Ninety-day ACM was 30.3%. HM (HR 1.90; 95% CI 1.04-3.46, p = 0.036) and ICU admission (HR 4.89; 95% CI 2.93-8.17, p < 0.001) but not neutropenia (HR 1.45; 95% CI 0.88-2.39, p = 0.135) were associated with mortality. Chronic kidney disease was also a significant predictor of death in the HM subgroup (HR 3.94; 95% CI 1.15-13.44, p = 0.028). Interpretation: IA is identified in high number of patients with mild/no immunosuppression in our study. The relatively high proportion of non- A. fumigatus species complex isolates and 6.5% azole-resistance rate amongst A. fumigatus sensu stricto necessitates accurate species identification and susceptibility testing for optimal patient outcomes. Funding: This work is unfunded. All authors' financial disclosures are listed in detail at the end of the manuscript. Competing Interests: This work itself is not funded. All authors declare no conflicts of interest associated with this publication, or any financial support that could have influenced its outcome. (© 2023 The Author(s).)
Databáze:	MEDLINE
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