Trends in incidence of invasive fungal infections at a tertiary cancer centre over a 14-year period: an autopsy study
Abstract number: 1133_199
Chamilos G., Bodey G.P., Luna M., Lewis R.E., Rolston K.V., Chemaly R., Safdar A., Raad I., Kontoyiannis D.P.
Autopsy series remain the most reliable way to study epidemiology of invasive fungal infections (IFI). We sought to identify trends in incidence of IFI and associated risk factors in cancer patients in our institution over the last 2 decades.
Autopsies of cancer patients at MDACC were analyzed over 3 study-periods (A: 19891993, B: 19941998,C: 19992002), each associated with the introduction of a new antifungal (A: fluconazole, B: lipid formulations of amphotericin B, C: echinocandins).
The median autopsy rate decreased significantly over the 3 study periods (219/year, 65/year, and 56/year respectively), (p = 0.02). 336 IFIs were identified in 1449 autopsies (23%). Most (94%) IFIs occurred in patients with haematological malignancies. The incidence of IFIs increased from 20% (19891993) to 30.5% (19941998) and 36.4% (19992002) in recent years (p < 0.0001). This trend was mainly associated by a significant increase in incidence of invasive aspergillosis after period A (8.4%, 16.5%, 20.4% in each period respectively, p < 0.0001). Non-fumigatus aspergilli were the most common causes of aspergillosis in our institution throughout all periods (65%, 56%, 63%, p = 0.28). In contrast, the incidence of candidiasis remained stable (8.4%, 10.1% and 8.0% respectively), (p = 0.68) while a predominance of non-albicans Candida strains occurred in period B and C (43%, 69%, 61%, p < 0.0001). A significant increase in incidence of zygomycosis (0.4%, 2.5%, 2.2%) (p = 0.002) and other non-Aspergillus mould infections was noted after period A (1.4%, 1,1% 5.3%) (p = 0.0002). Finally, Candida spp caused the majority of IFIs in patients with solid tumors (65% of all IFI), while aspergillosis and non-Aspergillus mould infections predominated in patients with hematologic malignancy and/or bone marrow transplantation (64% of all IFI).
Although Aspergillus and Candida continue to represent the majority of IFIs at autopsy, the epidemiology of IFIs is changing, with the emergence of resistant yeasts and moulds, especially among severely immunocompromissed cancer patients. The declining autopsy rates represent a challenge in the study of epidemiology of IFIs.
|Session name:||XXIst ISTH Congress|
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