title: Epidemiology and outcomes of patients with invasive mould infections: a retrospective observational study from a single centre (2005-2009).
abstract: Invasive mould infection (IMI) is an important cause of morbidity and mortality in immunocompromised patients. However, Swedish epidemiology data are lacking. The aim of this study was to investigate the epidemiology and outcome of IMI. Cases of proven/probable IMI at Karolinska University Hospital, Stockholm, from 2005 to 2009, were included. A total of 100 patients with 104 episodes of IMI were enrolled. Identified isolates included 101 mould isolates. The majority of the isolates were Aspergillus spp. (74.3%), followed by Mucorales spp. (13.9%), Fusarium spp. (4.9%) and other mould spp. (6.9%). In 13% of the episodes, more than one mould caused the IMI. The lung was most often affected (88.5%). The most frequent underlying disease was haematological malignancies (70%). Following diagnosis, 83.7% initially received antifungal monotherapy, 9.6% received combination therapy and 6.7% no treatment. The overall 90-day and 1-year overall survival was 49% and 46% respectively. Survival at 90 days post diagnosis was 71.4% in the solid tumour cohort, 62.5% in patients with solid organ transplants, 43.5% in haematological malignancy (HMs) and 37% in those undergoing allogeneic haematopoietic stem cell transplantation (HSCT). Overall survival was poor in the studied cohort, but is variable among different host categories, with particular opportunities for improvement in patients with underlying HMs and allogeneic HSCT.
authors.affiliation: Division of Clinical Microbiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Klingspor
authors.affiliation: Division of Clinical Microbiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Baharak
authors.initials: B
authors.lastname: Saaedi
authors.affiliation: Division of Haematology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Ljungman
authors.affiliation: Division of Pathology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Attila
authors.initials: A
authors.lastname: Szakos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D001230:Aspergillus / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D005658:Fungi / Q000145:classification* / Q000302:isolation & purification / Q000472:pathogenicity*; D005670:Fusarium / Q000302:isolation & purification; D019337:Hematologic Neoplasms / Q000150:complications / Q000382:microbiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D008297:Male; D008875:Middle Aged; D009090:Mucorales / Q000302:isolation & purification; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D063868:Patient Outcome Assessment; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Invasive mould infection; aspergillosis; epidemiology; fusariosis; mucormycosis; outcome