title: Improvement in the outcome of invasive fusariosis in the last decade.
abstract: Invasive fusariosis (IF) has been associated with a poor prognosis. Although recent series have reported improved outcomes, the definition of optimal treatments remains controversial. The objective of this study was to evaluate changes in the outcome of IF. We retrospectively analysed 233 cases of IF from 11 countries, comparing demographics, clinical findings, treatment and outcome in two periods: 1985-2000 (period 1) and 2001-2011 (period 2). Most patients (92%) had haematological disease. Primary treatment with deoxycholate amphotericin B was more frequent in period 1 (63% vs. 30%, p <0.001), whereas voriconazole (32% vs. 2%, p <0.001) and combination therapies (18% vs. 1%, p <0.001) were more frequent in period 2. The 90-day probabilities of survival in periods 1 and 2 were 22% and 43%, respectively (p <0.001). In period 2, the 90-day probabilities of survival were 60% with voriconazole, 53% with a lipid formulation of amphotericin B, and 28% with deoxycholate amphotericin B (p 0.04). Variables associated with poor prognosis (death 90 days after the diagnosis of fusariosis) by multivariable analysis were: receipt of corticosteroids (hazard ratio (HR) 2.11, 95% CI 1.18-3.76, p 0.01), neutropenia at end of treatment (HR 2.70, 95% CI 1.57-4.65, p <0.001), and receipt of deoxycholate amphotericin B (HR 1.83, 95% CI 1.06-3.16, p 0.03). Treatment practices have changed over the last decade, with an increased use of voriconazole and combination therapies. There has been a 21% increase in survival rate in the last decade.
authors.affiliation: University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Nucci
authors.forename: K A
authors.initials: KA
authors.lastname: Marr
authors.forename: M J G T
authors.initials: MJ
authors.lastname: Vehreschild
authors.forename: C A
authors.initials: CA
authors.lastname: de Souza
authors.forename: E
authors.initials: E
authors.lastname: Velasco
authors.forename: P
authors.initials: P
authors.lastname: Cappellano
authors.forename: F
authors.initials: F
authors.lastname: Carlesse
authors.forename: F
authors.initials: F
authors.lastname: Queiroz-Telles
authors.forename: D C
authors.initials: DC
authors.lastname: Sheppard
authors.forename: A
authors.initials: A
authors.lastname: Kindo
authors.forename: S
authors.initials: S
authors.lastname: Cesaro
authors.forename: N
authors.initials: N
authors.lastname: Hamerschlak
authors.forename: C
authors.initials: C
authors.lastname: Solza
authors.forename: W J
authors.initials: WJ
authors.lastname: Heinz
authors.forename: M
authors.initials: M
authors.lastname: Schaller
authors.forename: A
authors.initials: A
authors.lastname: Atalla
authors.forename: S
authors.initials: S
authors.lastname: Arikan-Akdagli
authors.forename: H
authors.initials: H
authors.lastname: Bertz
authors.forename: C
authors.initials: C
authors.lastname: Galvão Castro
authors.forename: R
authors.initials: R
authors.lastname: Herbrecht
authors.forename: M
authors.initials: M
authors.lastname: Hoenigl
authors.forename: G
authors.initials: G
authors.lastname: Härter
authors.forename: N E U
authors.initials: NE
authors.lastname: Hermansen
authors.forename: A
authors.initials: A
authors.lastname: Josting
authors.forename: L
authors.initials: L
authors.lastname: Pagano
authors.forename: M J C
authors.initials: MJ
authors.lastname: Salles
authors.forename: S B
authors.initials: SB
authors.lastname: Mossad
authors.forename: D
authors.initials: D
authors.lastname: Ogunc
authors.forename: A C
authors.initials: AC
authors.lastname: Pasqualotto
authors.forename: V
authors.initials: V
authors.lastname: Araujo
authors.forename: P F
authors.initials: PF
authors.lastname: Troke
authors.forename: O
authors.initials: O
authors.lastname: Lortholary
authors.forename: O A
authors.initials: OA
authors.lastname: Cornely
authors.forename: E
authors.initials: E
authors.lastname: Anaissie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003840:Deoxycholic Acid / Q000627:therapeutic use; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D060585:Fusariosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D065819:Voriconazole / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D004338:Drug Combinations; C068538:liposomal amphotericin B; D003840:Deoxycholic Acid; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination; D065819:Voriconazole
keywords: Epidemiology; fusariosis; outcome; treatment; voriconazole