Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database.
BACKGROUND
The incidence and epidemiology of invasive fungal infections (IFIs), a leading cause of death among hematopoeitic stem cell transplant (HSCT) recipients, are derived mainly from single-institution retrospective studies.


METHODS
The Transplant Associated Infections Surveillance Network, a network of 23 US transplant centers, prospectively enrolled HSCT recipients with proven and probable IFIs occurring between March 2001 and March 2006. We collected denominator data on all HSCTs preformed at each site and clinical, diagnostic, and outcome information for each IFI case. To estimate trends in IFI, we calculated the 12-month cumulative incidence among 9 sequential subcohorts.


RESULTS
We identified 983 IFIs among 875 HSCT recipients. The median age of the patients was 49 years; 60% were male. Invasive aspergillosis (43%), invasive candidiasis (28%), and zygomycosis (8%) were the most common IFIs. Fifty-nine percent and 61% of IFIs were recognized within 60 days of neutropenia and graft-versus-host disease, respectively. Median onset of candidiasis and aspergillosis after HSCT was 61 days and 99 days, respectively. Within a cohort of 16,200 HSCT recipients who received their first transplants between March 2001 and September 2005 and were followed up through March 2006, we identified 718 IFIs in 639 persons. Twelve-month cumulative incidences, based on the first IFI, were 7.7 cases per 100 transplants for matched unrelated allogeneic, 8.1 cases per 100 transplants for mismatched-related allogeneic, 5.8 cases per 100 transplants for matched-related allogeneic, and 1.2 cases per 100 transplants for autologous HSCT.


CONCLUSIONS
In this national prospective surveillance study of IFIs in HSCT recipients, the cumulative incidence was highest for aspergillosis, followed by candidiasis. Understanding the epidemiologic trends and burden of IFIs may lead to improved management strategies and study design.
Kontoyiannis
Dimitrios P
DP
The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. dkontoyi@mdanderson.org
Marr
Kieren A
KA
Park
Benjamin J
BJ
Alexander
Barbara D
BD
Anaissie
Elias J
EJ
Walsh
Thomas J
TJ
Ito
James
J
Andes
David R
DR
Baddley
John W
JW
Brown
Janice M
JM
Brumble
Lisa M
LM
Freifeld
Alison G
AG
Hadley
Susan
S
Herwaldt
Loreen A
LA
Kauffman
Carol A
CA
Knapp
Katherine
K
Lyon
G Marshall
GM
Morrison
Vicki A
VA
Papanicolaou
Genovefa
G
Patterson
Thomas F
TF
Perl
Trish M
TM
Schuster
Mindy G
MG
Walker
Randall
R
Wannemuehler
Kathleen A
KA
Wingard
John R
JR
Chiller
Tom M
TM
Pappas
Peter G
PG
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007223:Infant; D017053:Infection Control / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology*; D011446:Prospective Studies; D018571:Sentinel Surveillance; D014481:United States / Q000453:epidemiology; D055815:Young Adult