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Transpl Infect Dis. 2018 Dec;20(6):e12981. doi: 10.1111/tid.12981. Epub 2018 Sep 4.

Incidence and outcome of invasive fungal diseases after allogeneic hematopoietic stem cell transplantation: A Swiss transplant cohort study.

Author information

1
Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Basel, Basel, Switzerland.
2
Clinic for Transplantation Immunology and Nephrology, University Hospital of Basel, Basel, Switzerland.
3
Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
4
Division of Hematology, University Hospital of Basel, Basel, Switzerland.
5
Division of Hematology, University and University Hospital of Zurich, Zurich, Switzerland.
6
Clinic of Internal Medicine and Infectious Diseases, Clinica Luganese, Lugano, Switzerland.
7
Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
8
Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland.
9
Division of Hematology, University Hospital of Geneva, Geneva, Switzerland.
10
Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Zurich, Switzerland.
11
Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland.

Abstract

Contemporary, comprehensive data on epidemiology and outcomes of invasive fungal disease (IFD) including breakthrough IFD among allogeneic hematopoietic stem cell transplantation (HSCT) recipients are scarce. We included 479 allogeneic HSCT recipients with 10 invasive candidiasis (IC) and 31 probable/proven invasive mold disease (IMD) from the Swiss Transplant Cohort Study from 01.2009 to 08.2013. Overall cumulative incidence was 2.3% for IC and 8.5% for probable/proven IMI: 6% for invasive aspergillosis (IA) and 2.5% for non-AspergillusIMI. Among 41 IFD, 46% IFD were breakthrough, with an overall incidence of 4.6%, more frequently caused by other-than-Aspergillus fumigatus molds than primary IFD (47.6% (10/21) vs 13% (3/23), P = 0.04). Twelve-week mortality among patients with IC was 20% and 58.6% for probable/proven IMD (60% IA and 54.6% non-Aspergillus). Our results reveal that breakthrough IFD represent a marked burden of probable/proven IFD postallogeneic HSCT and mortality remains above 50% in patients with probable/proven IMD, underscoring the ongoing challenges to prevent and treat IFD in these patients.

KEYWORDS:

breakthrough infections; hematopoietic stem cell transplantation; invasive fungal diseases; invasive mold disease

PMID:
30144374
DOI:
10.1111/tid.12981
[Indexed for MEDLINE]

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