title: Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009.
abstract: BACKGROUND
  The study objectives were: 1) to report on invasive aspergillosis patients in a hematology department; and 2) to estimate its incidence according to the hematologic diagnosis.
  
  
  METHODS
  A prospective survey of invasive aspergillosis cases was undertaken between January 2004 and December 2009 in the hematology department of a university hospital. Meetings with clinicians, mycologists and infection control practitioners were organized monthly to confirm suspected aspergillosis cases. Demographic characteristics, clinical and complementary examination results were recorded prospectively. Information on hospitalization was extracted from administrative databases. Invasive aspergillosis diagnosis followed the European Organization for Research and Treatment of Cancer criteria, and proven and probable IA cases were retained. A descriptive analysis was conducted with temporal trends of invasive aspergillosis incidence assessed by adjusted Poisson regression.
  
  
  RESULTS
  Overall, 4,073 hospitalized patients (78,360 patient-days) were included in the study. In total, 127 (3.1%) patients presented invasive aspergillosis. The overall incidence was 1.6 per 1,000 patient-days (95% confidence interval: 1.4, 1.9) with a decrease of 16% per year (-1%, -28%). The incidence was 1.9 per 1,000 patient-days (1.5, 2.3) in acute myeloid leukemia patients with a decrease of 20% per year (-6%, -36%). Serum Aspergillus antigen was detected in 89 (71%) patients; 29 (23%) had positive cultures, and 118 (93%), abnormal lung CT scans. One-month mortality was 13%; 3-month mortality was 42%. Mortality tended to decrease between 2004 and 2009.
  
  
  CONCLUSIONS
  Invasive aspergillosis incidence and mortality declined between 2004 and 2009. Knowledge of invasive aspergillosis characteristics and its clinical course should help to improve the management of these patients with severe disease.
authors.affiliation: Service d’Hygiène, Epidémiologie et Prévention, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Nicolle
authors.forename: Thomas
authors.initials: T
authors.lastname: Bénet
authors.forename: Anne
authors.initials: A
authors.lastname: Thiebaut
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Bienvenu
authors.forename: Nicolas
authors.initials: N
authors.lastname: Voirin
authors.forename: Antoine
authors.initials: A
authors.lastname: Duclos
authors.forename: Mohamad
authors.initials: M
authors.lastname: Sobh
authors.forename: Giovanna
authors.initials: G
authors.lastname: Cannas
authors.forename: Xavier
authors.initials: X
authors.lastname: Thomas
authors.forename: Frank-Emmanuel
authors.initials: FE
authors.lastname: Nicolini
authors.forename: Frédérique
authors.initials: F
authors.lastname: De Monbrison
authors.forename: Marie-Antoinette
authors.initials: MA
authors.lastname: Piens
authors.forename: Stéphane
authors.initials: S
authors.lastname: Picot
authors.forename: Mauricette
authors.initials: M
authors.lastname: Michallet
authors.forename: Philippe
authors.initials: P
authors.lastname: Vanhems
mesh_terms: D000328:Adult; D000946:Antigens, Fungal / Q000097:blood*; D001228:Aspergillosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003625:Data Collection; D005260:Female; D019337:Hematologic Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012720:Severity of Illness Index
chemical_list: D000946:Antigens, Fungal