title: Epidemiological trends in invasive aspergillosis in France: the SAIF network (2005-2007).
abstract: A prospective (2005-2007) hospital-based multicentre surveillance of EORTC/MSG-proven or probable invasive aspergillosis (IA) cases whatever the underlying diseases was implemented in 12 French academic hospitals. Admissions per hospital and transplantation procedures were obtained. Cox regression models were used to determine risk factors associated with the 12-week overall mortality. With 424 case-patients included, the median incidence/hospital was 0.271/10(3) admissions (range 0.072-0.910) without significant alteration of incidence and seasonality over time. Among the 393 adults (62% men, 56 years (16-84 years)), 15% had proven IA, 78% haematological conditions, and 92.9% had lung involvement. Acute leukaemia (34.6%) and allogeneic stem cell transplantation (21.4%) were major host factors, together with chronic lymphoproliferative disorders (21.6%), which emerged as a new high-risk group. The other risk host factors consisted of solid organ transplantation (8.7%), solid tumours (4.3%), systemic inflammatory diseases (4.6%) and chronic respiratory diseases (2.3%). Serum galactomannan tests were more often positive (≥69%) for acute leukaemia and allogeneic stem cell transplantation than for the others (<42%; p <10(-3)). When positive (n = 245), cultures mainly yielded Aspergillus fumigatus (79.7%). First-line antifungal therapy consisted of voriconazole, caspofungin, lipid formulations of amphotericin, or any combination therapy (52%, 14%, 8% and 19.9%, respectively). Twelve-week overall mortality was 44.8% (95% CI, 39.8-50.0); it was 41% when first-line therapy included voriconazole and 60% otherwise (p <0.001). Independent factors for 12-week mortality were older age, positivity for both culture and galactomannan and central nervous system or pleural involvement, while any strategy containing voriconazole was protective.
authors.affiliation: Institut Pasteur, Centre National de Référence Mycologie et Antifongiques, Unité de Mycologie Moléculaire, Paris  CNRS URA3012, Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Lortholary
authors.forename: J-P
authors.initials: JP
authors.lastname: Gangneux
authors.forename: K
authors.initials: K
authors.lastname: Sitbon
authors.forename: B
authors.initials: B
authors.lastname: Lebeau
authors.forename: F
authors.initials: F
authors.lastname: de Monbrison
authors.forename: Y
authors.initials: Y
authors.lastname: Le Strat
authors.forename: B
authors.initials: B
authors.lastname: Coignard
authors.forename: F
authors.initials: F
authors.lastname: Dromer
authors.forename: S
authors.initials: S
authors.lastname: Bretagne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D001230:Aspergillus / Q000145:classification / Q000302:isolation & purification; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005602:France / Q000453:epidemiology; D005690:Galactose / Q000031:analogs & derivatives; D006761:Hospitals; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D055744:Invasive Pulmonary Aspergillosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D008297:Male; D008351:Mannans / Q000097:blood; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012621:Seasons; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D008351:Mannans; C012990:galactomannan; D005690:Galactose