title: Invasive infections due to filamentous fungi other than Aspergillus: epidemiology and determinants of mortality.
abstract: The epidemiology of invasive fungal disease (IFD) due to filamentous fungi other than Aspergillus may be changing. We analysed clinical, microbiological and outcome data in Australian patients to determine the predisposing factors and identify determinants of mortality. Proven and probable non-Aspergillus mould infections (defined according to modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria) from 2004 to 2012 were evaluated in a multicentre study. Variables associated with infection and mortality were determined. Of 162 episodes of non-Aspergillus IFD, 145 (89.5%) were proven infections and 17 (10.5%) were probable infections. The pathogens included 29 fungal species/species complexes; mucormycetes (45.7%) and Scedosporium species (33.3%) were most common. The commonest comorbidities were haematological malignancies (HMs) (46.3%) diabetes mellitus (23.5%), and chronic pulmonary disease (16%); antecedent trauma was present in 21% of cases. Twenty-five (15.4%) patients had no immunocompromised status or comorbidity, and were more likely to have acquired infection following major trauma (p <0.01); 61 (37.7%) of cases affected patients without HMs or transplantation. Antifungal therapy was administered to 93.2% of patients (median 68 days, interquartile range 19-275), and adjunctive surgery was performed in 58.6%. The all-cause 90-day mortality was 44.4%; HMs and intensive-care admission were the strongest predictors of death (both p <0.001). Survival varied by fungal group, with the risk of death being significantly lower in patients with dematiaceous mould infections than in patients with other non-Aspergillus mould infections. Non-Aspergillus IFD affected diverse patient groups, including non-immunocompromised hosts and those outside traditional risk groups; therefore, definitions of IFD in these patients are required. Given the high mortality, increased recognition of infections and accurate identification of the causative agent are required.
authors: Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Infectious Diseases Service at the Doherty Institute, Melbourne, Australia.
authors: M
authors: M
authors: Slavin
authors: Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia; Department of Infectious Diseases and Microbiology, Liverpool Hospital, Sydney, Australia.
authors: S
authors: S
authors: van Hal
authors: Centre for Infectious Diseases and Microbiology, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia.
authors: T C
authors: TC
authors: Sorrell
authors: Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia.
authors: A
authors: A
authors: Lee
authors: Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, Australia.
authors: D J
authors: DJ
authors: Marriott
authors: Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, Australia.
authors: K
authors: K
authors: Daveson
authors: Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, Australia.
authors: K
authors: K
authors: Kennedy
authors: Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors: K
authors: K
authors: Hajkowicz
authors: Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Sydney, Australia.
authors: C
authors: C
authors: Halliday
authors: Department of Infectious Diseases, Barwon Health, Deakin University, Geelong, Australia.
authors: E
authors: E
authors: Athan
authors: Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, Australia.
authors: N
authors: N
authors: Bak
authors: Department of Infectious Diseases and Microbiology, Concord Hospital, Sydney, Australia.
authors: E
authors: E
authors: Cheong
authors: Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Australia.
authors: C H
authors: CH
authors: Heath
authors: Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia.
authors: C
authors: C
authors: Orla Morrissey
authors: National Mycology Reference Laboratory, SA Pathology, Adelaide, Australia.
authors: S
authors: S
authors: Kidd
authors: Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, Australia.
authors: R
authors: R
authors: Beresford
authors: School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital, Perth, Australia.
authors: C
authors: C
authors: Blyth
authors: Monash Infectious Diseases and Monash University, Melbourne, Australia.
authors: T M
authors: TM
authors: Korman
authors: Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Australia; Australian Collaborating Centre for Enterococcus and Staphylococcus Species Typing and Research, School of Biomedical Sciences, Curtin University, Perth, Australia.
authors: J
authors: J
authors: Owen Robinson
authors: Centre for Infectious Diseases and Microbiology, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia; Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Sydney Medical School-Westmead Hospital, The University of Sydney, Westmead Millennium Institute, Sydney, Australia.
authors: W
authors: W
authors: Meyer
authors: Centre for Infectious Diseases and Microbiology, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia; Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Sydney, Australia; Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Sydney Medical School-Westmead Hospital, The University of Sydney, Westmead Millennium Institute, Sydney, Australia. Electronic address: Sharon.chen@health.nsw.gov.au.
authors: S C-A
authors: SC
authors: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents; D001315:Australia / Q000453:epidemiology; D002648:Child; D015897:Comorbidity; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D005658:Fungi / Q000145:classification* / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D016921:Meningitis, Fungal / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Determinants of outcome; epidemiology; filamentous fungus; non-Aspergillus moulds; predisposing factors