Invasive aspergillosis in adult patients in Australia and New Zealand: 2017-2020
- Author(s)
- Tio, SY; Chen, SCA; Hamilton, K; Heath, CH; Pradhan, A; Morris, AJ; Korman, TM; Morrissey, O; Halliday, CL; Kidd, S; Spelman, T; Brell, N; McMullan, B; Clark, JE; Mitsakos, K; Hardiman, RP; Williams, P; Campbell, AJ; Beardsley, J; Van Hal, S; Yong, MK; Worth, LJ; Slavin, MA;
- Journal Title
- Lancet Regional Health - Western Pacific
- Publication Type
- Research article
- Abstract
- BACKGROUND: New and emerging risks for invasive aspergillosis (IA) bring the need for contemporary analyses of the epidemiology and outcomes of IA, in order to improve clinical practice. METHODS: The study was a retrospective, multicenter, cohort design of proven and probable IA in adults from 10 Australasian tertiary centres (January 2017-December 2020). Descriptive analyses were used to report patients' demographics, predisposing factors, mycological characteristics, diagnosis and management. Accelerated failure-time model was employed to determine factor(s) associated with 90-day all-cause mortality (ACM). FINDINGS: Of 382 IA episodes, 221 (in 221 patients) fulfilled inclusion criteria - 53 proven and 168 probable IA. Median patient age was 61 years (IQR 51-69). Patients with haematologic malignancies (HM) comprised 49.8% of cases. Fifteen patients (6.8%) had no pre-specified immunosuppression and eleven patients (5.0%) had no documented comorbidity. Only 30% of patients had neutropenia. Of 170 isolates identified, 40 (23.5%) were identified as non-Aspergillus fumigatus species complex. Azole-resistance was present in 3/46 (6.5%) of A. fumigatus sensu stricto isolates. Ninety-day ACM was 30.3%. HM (HR 1.90; 95% CI 1.04-3.46, p = 0.036) and ICU admission (HR 4.89; 95% CI 2.93-8.17, p < 0.001) but not neutropenia (HR 1.45; 95% CI 0.88-2.39, p = 0.135) were associated with mortality. Chronic kidney disease was also a significant predictor of death in the HM subgroup (HR 3.94; 95% CI 1.15-13.44, p = 0.028). INTERPRETATION: IA is identified in high number of patients with mild/no immunosuppression in our study. The relatively high proportion of non-A. fumigatus species complex isolates and 6.5% azole-resistance rate amongst A. fumigatus sensu stricto necessitates accurate species identification and susceptibility testing for optimal patient outcomes. FUNDING: This work is unfunded. All authors' financial disclosures are listed in detail at the end of the manuscript.
- Publisher
- Elsevier
- Keywords
- Australasia; Epidemiology; Invasive aspergillosis; Outcome
- Department(s)
- Infectious Diseases; Health Services Research
- PubMed ID
- 37701716
- Publisher's Version
- https://doi.org/10.1016/j.lanwpc.2023.100888
- Open Access at Publisher's Site
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- Refer to copyright notice on published article.
Creation Date: 2023-11-21 05:54:38
Last Modified: 2023-11-21 05:55:40