Clinical epidemiology of 960 patients with invasive aspergillosis from the PATH Alliance registry.
OBJECTIVE
The study investigated the epidemiology and outcome of invasive aspergillosis (IA), an important cause of morbidity and mortality in immunocompromised patients.


METHODS
Cases of proven/probable IA from the Prospective Antifungal Therapy Alliance (PATH Alliance(®)) registry - a prospective surveillance network comprising 25 centers in the United States and Canada that collected data on invasive fungal infections from 2004 to 2008 - were analyzed with respect to clinical outcome.


RESULTS
Nine hundred and sixty patients with IA were enrolled, the most frequent underlying disease being hematologic malignancy (n=464 [48.3%]). Two hundred and eighty patients (29.2%) received solid organ transplant; 268 patients (27.9%) underwent hematopoietic stem cell transplantation. Identified isolates included Aspergillus fumigatus (72.6%), Aspergillus flavus (9.9%), Aspergillus niger (8.7%) and Aspergillus terreus (4.3%). The lung was most frequently affected. Following diagnosis, 47% patients received monotherapy - voriconazole (70%), an amphotericin B formulation (13.8%), or an echinocandin (10.5%) - while 279 patients (29%) received combination therapy. Twelve-week overall survival was 64.4%.


CONCLUSIONS
In this series of patients with IA, the lung was the predominant focus of infection, A. fumigatus was the major species isolated, and overall survival appeared slightly improved compared with previous reports.
Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA.
William J
WJ
Steinbach
Kieren A
KA
Marr
Elias J
EJ
Anaissie
Nkechi
N
Azie
Shun-Ping
SP
Quan
Herwig-Ulf
HU
Meier-Kriesche
Senu
S
Apewokin
David L
DL
Horn
D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D001230:Aspergillus / Q000145:classification / Q000302:isolation & purification; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000706:statistics & numerical data; D011446:Prospective Studies; D012042:Registries
D000935:Antifungal Agents