Clinical features and prognostic factors of Magnusiomyces (Saprochaete) infections in haematology. A multicentre study of SEIFEM/Fungiscope
Makaleler > Tam Makale · 2022
Yazarlar: Maria Ilaria Del Principe, Danila Seidel, Marianna Criscuolo, Michelina Dargenio, Zdenek Rácil, Monica Piedimonte, Francesco Marchesi, Gianpaolo Nadali, Philipp Koehler, Nicola Fracchiolla, Chiara Cattaneo, Nikolai Klimko, Angelica Spolzino, Deniz YILMAZ KARAPINAR, Hayati Demiraslan, Rafael F. Duarte, Judit Demeter, Marta Stanzani, Lorella Maria Antonia Melillo, Claudia Maria Basilico, Simone Cesaro, Giovangiacinto Paterno, Catello Califano, Mario Delia, Elisa Buzzatti, Alessandro Busca, Nael Alakel, Valentina Arsi'c Arsenijevi'c, Vincent Camus, Iker Falces‐Romero, Levy Itzhak, Michal Kouba, Rodrigo Martino, Petr Sedlacek, Barbora Weinbergerová, Oliver A. Cornely, Livio Pagano, FUNGISCOPE (Global Emerging Fungal Infection Registry) and the SEIFEM (Sorveglianza Epidemiologica Infezioni nelle Emopatie)
Mycoses, Uluslararası, Wos, 2022, cilt 66, ss 35-46
DOI: 10.1111/myc.13524
Özet
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.