Epidemiology and Outcome of Invasive Fungal Infection in Adult Hematopoietic Stem Cell Transplant Recipients: Analysis of Multicenter Prospective Antifungal Therapy (PATH) Alliance Registry
Background. With use of data from the Prospective Antifungal Therapy (PATH) Alliance registry, we performed this multicenter, prospective, observational study to assess the epidemiologic characters and outcomes of invasive fungal infection (IFI) in hematopoietic stem cell transplant (HSCT) recipient...
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| Veröffentlicht in: | Clinical infectious diseases 2009-02, Vol.48 (3), p.265-273 |
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| creator | Neofytos, D. Horn, D. Anaissie, E. Steinbach, W. Olyaei, A. Fishman, J. Pfaller, M. Chang, C. Webster, K. Marr, K. |
| description | Background. With use of data from the Prospective Antifungal Therapy (PATH) Alliance registry, we performed this multicenter, prospective, observational study to assess the epidemiologic characters and outcomes of invasive fungal infection (IFI) in hematopoietic stem cell transplant (HSCT) recipients. Methods. Sixteen medical centers from North America reported data on adult HSCT recipients with proven or probable IFI during the period July 2004 through September 2007. The distribution of IFIs and rates of survival at 6 and 12 weeks after diagnosis were studied. We used logistic regression models to determine risk factors associated with 6-week mortality for allogeneic HSCT recipients with invasive aspergillosis (IA). Results. Two hundred thirty-four adult HSCT recipients with a total of 250 IFIs were included in this study. IA (59.2%) was the most frequent IFI, followed by invasive candidiasis (24.8%), zygomycosis (7.2%), and IFI due to other molds (6.8%). Voriconazole was the most frequently administered agent (68.4%); amphotericin B deoxycholate was administered to a few patients (2.1%). Ninety-three (46.7%) of 199 HSCT recipients with known outcome had died by week 12. The 6-week survival rate was significantly greater for patients with IA than for those with invasive candidiasis and for those with IFI due to the Zygomycetes or other molds (P |
| doi_str_mv | 10.1086/595846 |
| format | Article |
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With use of data from the Prospective Antifungal Therapy (PATH) Alliance registry, we performed this multicenter, prospective, observational study to assess the epidemiologic characters and outcomes of invasive fungal infection (IFI) in hematopoietic stem cell transplant (HSCT) recipients. Methods. Sixteen medical centers from North America reported data on adult HSCT recipients with proven or probable IFI during the period July 2004 through September 2007. The distribution of IFIs and rates of survival at 6 and 12 weeks after diagnosis were studied. We used logistic regression models to determine risk factors associated with 6-week mortality for allogeneic HSCT recipients with invasive aspergillosis (IA). Results. Two hundred thirty-four adult HSCT recipients with a total of 250 IFIs were included in this study. IA (59.2%) was the most frequent IFI, followed by invasive candidiasis (24.8%), zygomycosis (7.2%), and IFI due to other molds (6.8%). Voriconazole was the most frequently administered agent (68.4%); amphotericin B deoxycholate was administered to a few patients (2.1%). Ninety-three (46.7%) of 199 HSCT recipients with known outcome had died by week 12. The 6-week survival rate was significantly greater for patients with IA than for those with invasive candidiasis and for those with IFI due to the Zygomycetes or other molds (P<.001). The 6-week mortality rate for HSCT recipients with IA was 21.5%. At 6 weeks, there was a trend toward a worse outcome among allogeneic HSCT recipients with IA who received myeloablative conditioning (P=.07); absence of mechanical ventilation or/and hemodialysis (P=.01) were associated with improved survival. Conclusions. IA remains the most commonly identified IFI among HSCT recipients, but rates of survival in persons with IA appear to have improved, compared with previously reported data. Invasive candidiasis and IFI due to molds other than Aspergillus species remain a significant problem in HSCT recipients.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1086/595846</identifier><identifier>PMID: 19115967</identifier><identifier>CODEN: CIDIEL</identifier><language>eng</language><publisher>Oxford: The University of Chicago Press</publisher><subject>Adult ; Adults ; Aged ; Amphotericin B - therapeutic use ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antifungal agents ; Antifungal Agents - therapeutic use ; Antifungals ; Articles and Commentaries ; Aspergillus ; Aspergillus - isolation & purification ; Biological and medical sciences ; Candida - isolation & purification ; Deoxycholic Acid - therapeutic use ; Drug Combinations ; Drug therapy ; Epidemiology ; Female ; Fungal infections ; Fungi ; Fungi - isolation & purification ; Health outcomes ; Hematopoietic Stem Cell Transplantation - adverse effects ; Hematopoietic stem cells ; Humans ; Infections ; Infectious diseases ; Logistic Models ; Male ; Medical sciences ; Middle Aged ; Mortality ; Mucorales - isolation & purification ; Mycoses - drug therapy ; Mycoses - epidemiology ; Mycoses - mortality ; North America ; Pharmacology. Drug treatments ; Predisposing factors ; Prevalence ; Prospective Studies ; Pyrimidines - therapeutic use ; Risk Factors ; Stem cells ; Transplantation ; Treatment Outcome ; Triazoles - therapeutic use ; Voriconazole ; Zygomycetes</subject><ispartof>Clinical infectious diseases, 2009-02, Vol.48 (3), p.265-273</ispartof><rights>Copyright 2008 Infectious Diseases Society of America</rights><rights>2009 by the Infectious Diseases Society of America 2009</rights><rights>2009 INIST-CNRS</rights><rights>Copyright University of Chicago, acting through its Press Feb 1, 2009</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c549t-94ad04c637bb98a0b3f02517ed889874345ef0c5a88059997519b026669085003</citedby><cites>FETCH-LOGICAL-c549t-94ad04c637bb98a0b3f02517ed889874345ef0c5a88059997519b026669085003</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/40309135$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/40309135$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,776,780,799,27901,27902,57992,58225</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21071814$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19115967$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Neofytos, D.</creatorcontrib><creatorcontrib>Horn, D.</creatorcontrib><creatorcontrib>Anaissie, E.</creatorcontrib><creatorcontrib>Steinbach, W.</creatorcontrib><creatorcontrib>Olyaei, A.</creatorcontrib><creatorcontrib>Fishman, J.</creatorcontrib><creatorcontrib>Pfaller, M.</creatorcontrib><creatorcontrib>Chang, C.</creatorcontrib><creatorcontrib>Webster, K.</creatorcontrib><creatorcontrib>Marr, K.</creatorcontrib><title>Epidemiology and Outcome of Invasive Fungal Infection in Adult Hematopoietic Stem Cell Transplant Recipients: Analysis of Multicenter Prospective Antifungal Therapy (PATH) Alliance Registry</title><title>Clinical infectious diseases</title><addtitle>Clinical Infectious Diseases</addtitle><addtitle>Clinical Infectious Diseases</addtitle><description>Background. With use of data from the Prospective Antifungal Therapy (PATH) Alliance registry, we performed this multicenter, prospective, observational study to assess the epidemiologic characters and outcomes of invasive fungal infection (IFI) in hematopoietic stem cell transplant (HSCT) recipients. Methods. Sixteen medical centers from North America reported data on adult HSCT recipients with proven or probable IFI during the period July 2004 through September 2007. The distribution of IFIs and rates of survival at 6 and 12 weeks after diagnosis were studied. We used logistic regression models to determine risk factors associated with 6-week mortality for allogeneic HSCT recipients with invasive aspergillosis (IA). Results. Two hundred thirty-four adult HSCT recipients with a total of 250 IFIs were included in this study. IA (59.2%) was the most frequent IFI, followed by invasive candidiasis (24.8%), zygomycosis (7.2%), and IFI due to other molds (6.8%). Voriconazole was the most frequently administered agent (68.4%); amphotericin B deoxycholate was administered to a few patients (2.1%). Ninety-three (46.7%) of 199 HSCT recipients with known outcome had died by week 12. The 6-week survival rate was significantly greater for patients with IA than for those with invasive candidiasis and for those with IFI due to the Zygomycetes or other molds (P<.001). The 6-week mortality rate for HSCT recipients with IA was 21.5%. At 6 weeks, there was a trend toward a worse outcome among allogeneic HSCT recipients with IA who received myeloablative conditioning (P=.07); absence of mechanical ventilation or/and hemodialysis (P=.01) were associated with improved survival. Conclusions. IA remains the most commonly identified IFI among HSCT recipients, but rates of survival in persons with IA appear to have improved, compared with previously reported data. Invasive candidiasis and IFI due to molds other than Aspergillus species remain a significant problem in HSCT recipients.</description><subject>Adult</subject><subject>Adults</subject><subject>Aged</subject><subject>Amphotericin B - therapeutic use</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antifungal agents</subject><subject>Antifungal Agents - therapeutic use</subject><subject>Antifungals</subject><subject>Articles and Commentaries</subject><subject>Aspergillus</subject><subject>Aspergillus - isolation & purification</subject><subject>Biological and medical sciences</subject><subject>Candida - isolation & purification</subject><subject>Deoxycholic Acid - therapeutic use</subject><subject>Drug Combinations</subject><subject>Drug therapy</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Fungal infections</subject><subject>Fungi</subject><subject>Fungi - isolation & purification</subject><subject>Health outcomes</subject><subject>Hematopoietic Stem Cell Transplantation - adverse effects</subject><subject>Hematopoietic stem cells</subject><subject>Humans</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Mucorales - isolation & purification</subject><subject>Mycoses - drug therapy</subject><subject>Mycoses - epidemiology</subject><subject>Mycoses - mortality</subject><subject>North America</subject><subject>Pharmacology. Drug treatments</subject><subject>Predisposing factors</subject><subject>Prevalence</subject><subject>Prospective Studies</subject><subject>Pyrimidines - therapeutic use</subject><subject>Risk Factors</subject><subject>Stem cells</subject><subject>Transplantation</subject><subject>Treatment Outcome</subject><subject>Triazoles - therapeutic use</subject><subject>Voriconazole</subject><subject>Zygomycetes</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkd-K1DAUxoso7jrqGyhRUPSimkybNPGulN2dhZFdtKJ4UzJpOmY2TWqSLvbhfDczdBhFEK_y5_zyfSfnS5LHCL5BkJK3mGGakzvJKcJZkRLM0N24h5imOc3oSfLA-x2ECFGI7ycniCGEGSlOk59ng2plr6y22wlw04KrMQjbS2A7cGluuVe3EpyPZst1PHdSBGUNUAaU7agDWMmeBztYJYMS4GOQPaik1qB23PhBcxPABynUoKQJ_h0oDdeTV36v_j6-VyLeSweunfXDXjualSaobjasv0nHhwm8ui7r1WtQaq24ETJKbpUPbnqY3Ou49vLRYV0kn87P6mqVrq8uLqtynQqcs5CynLcwFyQrNhtGOdxkHVxiVMiWUkaLPMux7KDAnMbxMMYKjNgGLgkhDFIMYbZIXs66g7PfR-lD0ysv4j-5kXb0DSEUIozIf8ElyrPoRiP4_C9wZ0cXp7NnGMMFI3-oiTge72TXDE713E0Ngs0-9maOPYJPD2rjppftb-yQcwReHADuBdddTEcof-SWCBaIxt4WybOZs-Pwb7MnM7PzwbojlcMMMpThWE_neoxI_jjWubtpYicFblZfvjb1RVXln9G6Qdkv7jrXVA</recordid><startdate>20090201</startdate><enddate>20090201</enddate><creator>Neofytos, D.</creator><creator>Horn, D.</creator><creator>Anaissie, E.</creator><creator>Steinbach, W.</creator><creator>Olyaei, A.</creator><creator>Fishman, J.</creator><creator>Pfaller, M.</creator><creator>Chang, C.</creator><creator>Webster, K.</creator><creator>Marr, K.</creator><general>The University of Chicago Press</general><general>University of Chicago Press</general><general>Oxford University Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7QO</scope><scope>7X8</scope></search><sort><creationdate>20090201</creationdate><title>Epidemiology and Outcome of Invasive Fungal Infection in Adult Hematopoietic Stem Cell Transplant Recipients: Analysis of Multicenter Prospective Antifungal Therapy (PATH) Alliance Registry</title><author>Neofytos, D. ; Horn, D. ; Anaissie, E. ; Steinbach, W. ; Olyaei, A. ; Fishman, J. ; Pfaller, M. ; Chang, C. ; Webster, K. ; Marr, K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c549t-94ad04c637bb98a0b3f02517ed889874345ef0c5a88059997519b026669085003</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adult</topic><topic>Adults</topic><topic>Aged</topic><topic>Amphotericin B - therapeutic use</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Antifungal agents</topic><topic>Antifungal Agents - therapeutic use</topic><topic>Antifungals</topic><topic>Articles and Commentaries</topic><topic>Aspergillus</topic><topic>Aspergillus - isolation & purification</topic><topic>Biological and medical sciences</topic><topic>Candida - isolation & purification</topic><topic>Deoxycholic Acid - therapeutic use</topic><topic>Drug Combinations</topic><topic>Drug therapy</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Fungal infections</topic><topic>Fungi</topic><topic>Fungi - isolation & purification</topic><topic>Health outcomes</topic><topic>Hematopoietic Stem Cell Transplantation - adverse effects</topic><topic>Hematopoietic stem cells</topic><topic>Humans</topic><topic>Infections</topic><topic>Infectious diseases</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Mucorales - isolation & purification</topic><topic>Mycoses - drug therapy</topic><topic>Mycoses - epidemiology</topic><topic>Mycoses - mortality</topic><topic>North America</topic><topic>Pharmacology. Drug treatments</topic><topic>Predisposing factors</topic><topic>Prevalence</topic><topic>Prospective Studies</topic><topic>Pyrimidines - therapeutic use</topic><topic>Risk Factors</topic><topic>Stem cells</topic><topic>Transplantation</topic><topic>Treatment Outcome</topic><topic>Triazoles - therapeutic use</topic><topic>Voriconazole</topic><topic>Zygomycetes</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Neofytos, D.</creatorcontrib><creatorcontrib>Horn, D.</creatorcontrib><creatorcontrib>Anaissie, E.</creatorcontrib><creatorcontrib>Steinbach, W.</creatorcontrib><creatorcontrib>Olyaei, A.</creatorcontrib><creatorcontrib>Fishman, J.</creatorcontrib><creatorcontrib>Pfaller, M.</creatorcontrib><creatorcontrib>Chang, C.</creatorcontrib><creatorcontrib>Webster, K.</creatorcontrib><creatorcontrib>Marr, K.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Biotechnology Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Neofytos, D.</au><au>Horn, D.</au><au>Anaissie, E.</au><au>Steinbach, W.</au><au>Olyaei, A.</au><au>Fishman, J.</au><au>Pfaller, M.</au><au>Chang, C.</au><au>Webster, K.</au><au>Marr, K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Epidemiology and Outcome of Invasive Fungal Infection in Adult Hematopoietic Stem Cell Transplant Recipients: Analysis of Multicenter Prospective Antifungal Therapy (PATH) Alliance Registry</atitle><jtitle>Clinical infectious diseases</jtitle><stitle>Clinical Infectious Diseases</stitle><addtitle>Clinical Infectious Diseases</addtitle><date>2009-02-01</date><risdate>2009</risdate><volume>48</volume><issue>3</issue><spage>265</spage><epage>273</epage><pages>265-273</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><coden>CIDIEL</coden><abstract>Background. With use of data from the Prospective Antifungal Therapy (PATH) Alliance registry, we performed this multicenter, prospective, observational study to assess the epidemiologic characters and outcomes of invasive fungal infection (IFI) in hematopoietic stem cell transplant (HSCT) recipients. Methods. Sixteen medical centers from North America reported data on adult HSCT recipients with proven or probable IFI during the period July 2004 through September 2007. The distribution of IFIs and rates of survival at 6 and 12 weeks after diagnosis were studied. We used logistic regression models to determine risk factors associated with 6-week mortality for allogeneic HSCT recipients with invasive aspergillosis (IA). Results. Two hundred thirty-four adult HSCT recipients with a total of 250 IFIs were included in this study. IA (59.2%) was the most frequent IFI, followed by invasive candidiasis (24.8%), zygomycosis (7.2%), and IFI due to other molds (6.8%). Voriconazole was the most frequently administered agent (68.4%); amphotericin B deoxycholate was administered to a few patients (2.1%). Ninety-three (46.7%) of 199 HSCT recipients with known outcome had died by week 12. The 6-week survival rate was significantly greater for patients with IA than for those with invasive candidiasis and for those with IFI due to the Zygomycetes or other molds (P<.001). The 6-week mortality rate for HSCT recipients with IA was 21.5%. At 6 weeks, there was a trend toward a worse outcome among allogeneic HSCT recipients with IA who received myeloablative conditioning (P=.07); absence of mechanical ventilation or/and hemodialysis (P=.01) were associated with improved survival. Conclusions. IA remains the most commonly identified IFI among HSCT recipients, but rates of survival in persons with IA appear to have improved, compared with previously reported data. Invasive candidiasis and IFI due to molds other than Aspergillus species remain a significant problem in HSCT recipients.</abstract><cop>Oxford</cop><pub>The University of Chicago Press</pub><pmid>19115967</pmid><doi>10.1086/595846</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1058-4838 |
| ispartof | Clinical infectious diseases, 2009-02, Vol.48 (3), p.265-273 |
| issn | 1058-4838 1537-6591 |
| language | eng |
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| source | Jstor Complete Legacy; Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Adults Aged Amphotericin B - therapeutic use Antibiotics. Antiinfectious agents. Antiparasitic agents Antifungal agents Antifungal Agents - therapeutic use Antifungals Articles and Commentaries Aspergillus Aspergillus - isolation & purification Biological and medical sciences Candida - isolation & purification Deoxycholic Acid - therapeutic use Drug Combinations Drug therapy Epidemiology Female Fungal infections Fungi Fungi - isolation & purification Health outcomes Hematopoietic Stem Cell Transplantation - adverse effects Hematopoietic stem cells Humans Infections Infectious diseases Logistic Models Male Medical sciences Middle Aged Mortality Mucorales - isolation & purification Mycoses - drug therapy Mycoses - epidemiology Mycoses - mortality North America Pharmacology. Drug treatments Predisposing factors Prevalence Prospective Studies Pyrimidines - therapeutic use Risk Factors Stem cells Transplantation Treatment Outcome Triazoles - therapeutic use Voriconazole Zygomycetes |
| title | Epidemiology and Outcome of Invasive Fungal Infection in Adult Hematopoietic Stem Cell Transplant Recipients: Analysis of Multicenter Prospective Antifungal Therapy (PATH) Alliance Registry |
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