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Invasive aspergillosis in adult patients in Australia and New Zealand: 2017-2020.
Tio, Shio Yen; Chen, Sharon C-A; Hamilton, Kate; Heath, Christopher H; Pradhan, Alyssa; Morris, Arthur J; Korman, Tony M; Morrissey, Orla; Halliday, Catriona L; Kidd, Sarah; Spelman, Timothy; Brell, Nadiya; McMullan, Brendan; Clark, Julia E; Mitsakos, Katerina; Hardiman, Robyn P; Williams, Phoebe; Campbell, Anita J; Beardsley, Justin; Van Hal, Sebastiaan; Yong, Michelle K; Worth, Leon J; Slavin, Monica A.
Affiliation
  • Tio SY; Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.
  • Chen SC; National Centre for Infections in Cancer, Melbourne, Australia.
  • Hamilton K; Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia.
  • Heath CH; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia.
  • Pradhan A; Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia.
  • Morris AJ; School of Medicine, University of Sydney, Australia.
  • Korman TM; Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia.
  • Morrissey O; Department of Microbiology, PathWest Laboratory Medicine, Murdoch, Western Australia, Australia.
  • Halliday CL; Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
  • Kidd S; Department of Medicine, University of Western Australia, Crawley, Western Australia, Australia.
  • Spelman T; Prince of Wales Hospital, Southeast Sydney LHD, NSW Health Pathology, Australia.
  • Brell N; School of Medicine, University of Sydney, Australia.
  • McMullan B; Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand.
  • Clark JE; Monash University and Monash Health, Clayton, Victoria, Australia.
  • Mitsakos K; Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia.
  • Hardiman RP; Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia.
  • Williams P; School of Medicine, University of Sydney, Australia.
  • Campbell AJ; National Mycology Reference Centre, Microbiology & Infectious Diseases, SA Pathology, Adelaide, South Australia, Australia.
  • Beardsley J; Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
  • Van Hal S; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
  • Yong MK; Prince of Wales Hospital, Southeast Sydney LHD, NSW Health Pathology, Australia.
  • Worth LJ; University of New South Wales, Australia.
  • Slavin MA; Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Australia.
Lancet Reg Health West Pac ; 40: 100888, 2023 Nov.
Article in En | MEDLINE | ID: mdl-37701716
ABSTRACT

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.
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Full text: 1 Database: MEDLINE Type of study: Clinical_trials / Prognostic_studies Language: En Journal: Lancet Reg Health West Pac Year: 2023 Type: Article Affiliation country: Australia
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Full text: 1 Database: MEDLINE Type of study: Clinical_trials / Prognostic_studies Language: En Journal: Lancet Reg Health West Pac Year: 2023 Type: Article Affiliation country: Australia