Breakthrough invasive fungal infection among patients with haematologic malignancies: A national, prospective, and multicentre study

作者：Pedro Puerta‐Alcalde, Patricia Monzó, Manuela Aguilar‐Guisado, Juan Carlos Ramos Ramos, Júlia Laporte-Amargós, Marina Machado, Pilar Martín‐Dávila, Mireia Franch‐Sarto, Isabel Sánchez‐Romero, Jon Badiola, Lucía Gómez, Isabel Ruíz-Camps, Lucrecia Yáñez, Lourdes Vázquez, Mariana Chumbita, Francesc Marco, Àlex Soriano, Pedro González, Ana Fernández‐Cruz, Montserrat Batlle, Jesús Fortün, Jesús Guinea, Carlota Gudiol, Julio García, Maite Ruiz Pérez de Pipaón, Ana Alastruey‐Izquierdo, Carolina García‐Vidal · 发表于：Journal of Infection · 年份：2023 · DOI：10.1016/j.jinf.2023.05.005 · 被引用次数：74 · 研究领域：Antifungal resistance and susceptibility、Fungal Infections and Studies、Neutropenia and Cancer Infections

OBJECTIVES: We describe the current epidemiology, causes, and outcomes of breakthrough invasive fungal infections (BtIFI) in patients with haematologic malignancies. METHODS: BtIFI in patients with ≥ 7 days of prior antifungals were prospectively diagnosed (36 months across 13 Spanish hospitals) according to revised EORTC/MSG definitions. RESULTS: 121 episodes of BtIFI were documented, of which 41 (33.9%) were proven; 53 (43.8%), probable; and 27 (22.3%), possible. The most frequent prior antifungals included posaconazole (32.2%), echinocandins (28.9%) and fluconazole (24.8%)-mainly for primary prophylaxis (81%). The most common haematologic malignancy was acute leukaemia (64.5%), and 59 (48.8%) patients had undergone a hematopoietic stem-cell transplantation. Invasive aspergillosis, principally caused by non-fumigatus Aspergillus, was the most frequent BtIFI with 55 (45.5%) episodes recorded, followed by candidemia (23, 19%), mucormycosis (7, 5.8%), other moulds (6, 5%) and other yeasts (5, 4.1%). Azole resistance/non-susceptibility was commonly found. Prior antifungal therapy widely determined BtIFI epidemiology. The most common cause of BtIFI in proven and probable cases was the lack of activity of the prior antifungal (63, 67.0%). At diagnosis, antifungal therapy was mostly changed (90.9%), mainly to liposomal amphotericin-B (48.8%). Overall, 100-day mortality was 47.1%; BtIFI was either the cause or an essential contributing factor to death in 61.4% of cases. CONCLUSIONS...