title: Epidemiology and outcomes of invasive fungal infections in allogeneic haematopoietic stem cell transplant recipients in the era of antifungal prophylaxis: a single-centre study with focus on emerging pathogens.
abstract: With increased use of expanded-spectrum triazoles for antifungal prophylaxis, the epidemiology of invasive fungal infections (IFIs) after allogeneic haematopoietic stem cell transplantation (HSCT) continues to evolve. To define the contemporary epidemiology of IFIs in this population, we reviewed all European Organization for Research and Treatment of Cancer-Mycoses Study Group proven and probable IFIs in adults transplanted from 2002 to 2011 and determined the incidence and risk factors for IFI and post-IFI mortality. All patients received antifungal prophylaxis. Fifty-three (14%) of 378 allogeneic HSCT recipients developed an IFI. There were 62 IFI episodes, of which aspergillosis (n = 31; 50%) and candidaemia (n = 15; 24%) were most common. Sixteen episodes (26%) were caused by other fungi, including Mucorales (n = 6; 10%) and the following uncommon pathogens: Trichosporon asahii, Arthrographis sp., Cladosporium sp., Geosmithia argillacea and Hormographiella aspergillata. Independent IFI risk factors were hospitalisation in an intensive care unit [ICU; odds ratio (OR) = 6.0], graft-versus-host disease (OR = 5.3), central venous catheter use (OR = 5.2) and hypoalbuminaemia (OR = 0.3 g(-1)  dl(-1) increase in albumin). The 90-day mortality rate after IFI was 57%. Non-cytomegalovirus systemic viral co-infection (OR = 3.5) and stay in an ICU (OR = 2.9) were independent risk factors for death. Despite antifungal prophylaxis, IFIs remain common after allogeneic HSCT and previously uncommon pathogens are emerging.
authors: Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Mexico City, Mexico.|Transplatation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, USA.
authors: Dora E
authors: DE
authors: Corzo-León
authors: Transplatation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, USA.|New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
authors: Michael J
authors: MJ
authors: Satlin
authors: Transplatation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, USA.|New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
authors: Rosemary
authors: R
authors: Soave
authors: New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.|Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY, USA.
authors: Tsiporah B
authors: TB
authors: Shore
authors: New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.|Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA.
authors: Audrey N
authors: AN
authors: Schuetz
authors: Transplatation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, USA.|New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
authors: Samantha E
authors: SE
authors: Jacobs
authors: Transplatation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, USA.|New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.|Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA.|Department of Microbiology and Immunology, Weill Cornell Medical College, New York, NY, USA.
authors: Thomas J
authors: TJ
authors: Walsh
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D020314:Central Nervous System Fungal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D018890:Chemoprevention / Q000379:methods*; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005658:Fungi / Q000145:classification* / Q000302:isolation & purification; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents
keywords: Invasive fungal infections; allogeneic stem cell transplantation