Factors Associated with Overall and Attributable Mortality in Invasive Aspergillosis
Yasmine Nivoix,Michel Velten,Valérie Letscher-Bru,Alireza Moghaddam,Shanti Natarajan-Amé,Cécile Fohrer,Bruno Lioure,Karin Bilger,Philippe Lutun,Luc Marcellin,Anne Launoy,Guy Freys,Jean-Pierre Bergerat,Raoul Herbrecht +13 more
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Kohno et al. as discussed by the authors retrospectively reviewed 385 cases of suspected or documented aspergillosis that occurred during a 9-year period and identified 289 episodes that fulfilled the criteria for possible, probable, or proven invasive Aspergillus active antifungal drug treatment.Abstract:
7 Laboratoire d'Epidemiologie et de SantePublique, Faculted e Medecine, UniversiteLouis Pasteur, Strasbourg, France (See the editorial commentary by Kohno on pages XXX-XX) Background. Invasive aspergillosis is associated with high death rates. Factors associated with increased mor- tality have not yet been identified in a large population of patients with various underlying conditions. Methods. We retrospectively reviewed 385 cases of suspected or documented aspergillosis that occurred during a 9-year period. We identified 289 episodes that fulfilled the criteria for possible, probable, or proven invasive aspergillosis according to the international definition criteria and that was treated with an anti-Aspergillus active antifungal drug. Clinical and microbiological variables were analyzed for their effects on overall and attributable mortality. Significant variables in univariate analysis were introduced into a multivariate Cox model. Results. Twelve-week overall and disease-specific survival rates were 52.2% (95% confidence interval, 46.5%- 57.9%) and 59.8% (95% confidence interval, 54.0%-65.4%), respectively. Receipt of allogeneic hematopoietic stem cell or solid-organ transplant, progression of underlying malignancy, prior respiratory disease, receipt of corti- costeroid therapy, renal impairment, low monocyte counts, disseminated aspergillosis, diffuse pulmonary lesions, pleural effusion, and proven or probable (as opposed to possible) aspergillosis are predictors of increased overall mortality. Similar factors are also predictors of increased attributable mortality, with the following exceptions: pleural effusion and low monocyte counts have no impact, whereas neutropenia is associated with a higher attributable mortality. Conclusions. Identification of predictors of death helps in the identification of patients who could benefit from more-aggressive therapeutic strategies. Initiation of therapy at the stage of possible infection improves out- come, and this finding calls for the development of efficient preemptive strategies to fill the gap between empirical and directed therapy.read more
Citations
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Journal ArticleDOI
Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline
Andrew J. Ullmann,José María Aguado,S. Arikan-Akdagli,David W. Denning,Andreas H. Groll,Katrien Lagrou,Cornelia Lass-Flörl,Russell E. Lewis,Patricia Muñoz,Paul E. Verweij,Adilia Warris,Florence Ader,Florence Ader,Murat Akova,Maiken Cavling Arendrup,Rosemary Ann Barnes,Catherine Beigelman-Aubry,Catherine Beigelman-Aubry,Stijn Blot,Stijn Blot,Stijn Blot,Emilio Bouza,Roger J. M. Brüggemann,Dieter Buchheidt,Jacques Cadranel,Jacques Cadranel,Elio Castagnola,Arunaloke Chakrabarti,Manuel Cuenca-Estrella,George Dimopoulos,George Dimopoulos,Jesús Fortún,Jean-Pierre Gangneux,Jorge Garbino,Werner J. Heinz,Raoul Herbrecht,Claus Peter Heussel,Christopher C. Kibbler,Nikolay Klimko,Bart Jan Kullberg,Christoph Lange,Thomas Lehrnbecher,Jürgen Löffler,Olivier Lortholary,J Maertens,O. Marchetti,Jacques F. Meis,Livio Pagano,Patricia Ribaud,Malcolm Richardson,Emmanuel Roilides,Markus Ruhnke,Maurizio Sanguinetti,Donald C. Sheppard,János Sinkó,Anna Skiada,Maria J G T Vehreschild,Claudio Viscoli,Oliver A. Cornely +58 more
TL;DR: Treatment duration for aspergillosis is strongly recommended based on clinical improvement, degree of immunosuppression and response on imaging, and in refractory disease, where a personalized approach considering reversal of predisposing factors, switching drug class and surgical intervention is also strongly recommended.
Journal ArticleDOI
A Clinical Algorithm to Diagnose Invasive Pulmonary Aspergillosis in Critically Ill Patients
Stijn Blot,Fabio Silvio Taccone,Anne-Marie Van den Abeele,Pierre Bulpa,Wouter Meersseman,Nele Brusselaers,George Dimopoulos,José A. Paiva,Benoit Misset,Jordi Rello,Koenraad Vandewoude,Dirk Vogelaers,AspICU Study Investigators +12 more
TL;DR: The algorithm demonstrated favorable operating characteristics to discriminate Aspergillus respiratory tract colonization from invasive pulmonary aspergillosis in critically ill patients.
Journal ArticleDOI
Randomized, double-blind trial of fluconazole versus voriconazole for prevention of invasive fungal infection after allogeneic hematopoietic cell transplantation
John R. Wingard,Shelly L. Carter,Thomas J. Walsh,Joanne Kurtzberg,Trudy N. Small,Lindsey R. Baden,Iris D. Gersten,Adam Mendizabal,Helen Leather,Dennis L. Confer,Richard T. Maziarz,Edward A. Stadtmauer,Javier Bolaños-Meade,Janice M. Brown,John F. DiPersio,Michael Boeckh,Kieren A. Marr,Kieren A. Marr +17 more
TL;DR: It is demonstrated that in the context of intensive monitoring and structured empiric antifungal therapy, 6-month FFS and overall survival did not differ in allogeneic HCT recipients given prophylactic fluconazole or voriconazole.
Journal ArticleDOI
Therapy for fungal diseases: opportunities and priorities
David W. Denning,William W. Hope +1 more
TL;DR: A perspective on the current status of drug therapy for invasive fungal diseases, together with priorities for the future development of novel compounds, and opportunities for new developments are discussed.
Journal ArticleDOI
Clinical epidemiology of 960 patients with invasive aspergillosis from the PATH Alliance registry.
William J. Steinbach,Kieren A. Marr,Elias Anaissie,Nkechi Azie,Shun Ping Quan,Herwig Ulf Meier-Kriesche,Senu Apewokin,David Horn +7 more
TL;DR: 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.
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