Clinical features and prognostic factors of Magnusiomyces (Saprochaete) infections in haematology. A multicentre study of SEIFEM/Fungiscope

Medientyp: E-Artikel
Titel: Clinical features and prognostic factors of Magnusiomyces (Saprochaete) infections in haematology. A multicentre study of SEIFEM/Fungiscope
Beteiligte: Del Principe, Maria Ilaria; Seidel, Danila; Criscuolo, Marianna; Dargenio, Michelina; Rácil, Zdenek; Piedimonte, Monica; Marchesi, Francesco; Nadali, Gianpaolo; Koehler, Philipp; Fracchiolla, Nicola; Cattaneo, Chiara; Klimko, Nikolai; Spolzino, Angelica; Yilmaz Karapinar, Deniz; Demiraslan, Hayati; Duarte, Rafael F.; Demeter, Judit; Stanzani, Marta; Melillo, Lorella Maria Antonia; Basilico, Claudia Maria; Cesaro, Simone; Paterno, Giovangiacinto; Califano, Catello; Delia, Mario; [...]
Erschienen: Wiley, 2023
Erschienen in: Mycoses
Sprache: Englisch
DOI: 10.1111/myc.13524
ISSN: 0933-7407; 1439-0507
Schlagwörter: Infectious Diseases ; Dermatology ; General Medicine
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Beschreibung: <jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Our multicentre study aims to identify baseline factors and provide guidance for therapeutic decisions regarding <jats:italic>Magnusiomyces</jats:italic>‐associated infections, an emerging threat in patients with haematological malignancies.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>HM patients with proven (<jats:italic>Magnusiomyces capitatus</jats:italic>) <jats:italic>M. capitatus</jats:italic> or (<jats:italic>Magnusiomyces clavatus</jats:italic>) <jats:italic>M. clavatus</jats:italic> (formerly <jats:italic>Saprochaete capitata</jats:italic> and <jats:italic>Saprochaete clavata</jats:italic>) infection diagnosed between January 2010 and December 2020 were recorded from the SEIFEM (Sorveglianza Epidemiologica Infezioni nelle Emopatie) group and FungiScope (Global Emerging Fungal Infection Registry). Cases of <jats:italic>Magnusiomyces fungemia</jats:italic> were compared with candidemia.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among 90 <jats:italic>Magnusiomyces</jats:italic> cases (60 [66%] <jats:italic>M. capitatus</jats:italic> and 30 (34%) <jats:italic>M. clavatus</jats:italic>), median age was 50 years (range 2–78), 46 patients (51%) were female and 67 (74%) had acute leukaemia. Thirty‐six (40%) of <jats:italic>Magnusiomyces</jats:italic>‐associated infections occurred during antifungal prophylaxis, mainly with posaconazole (<jats:italic>n</jats:italic> = 13, 36%) and echinocandins (<jats:italic>n</jats:italic> = 12, 34%). Instead, the candidemia rarely occurred during prophylaxis (<jats:italic>p</jats:italic> < .0001). First‐line antifungal therapy with azoles, alone or in combination, was associated with improved response compared to other antifungals (<jats:italic>p</jats:italic> = .001). Overall day‐30 mortality rate was 43%. Factors associated with higher mortality rates were septic shock (HR 2.696, 95% CI 1.396–5.204, <jats:italic>p</jats:italic> = .003), corticosteroid treatment longer than 14 days (HR 2.245, 95% CI 1.151–4.376, <jats:italic>p</jats:italic> = .018) and lack of neutrophil recovery (HR 3.997, 95% CI 2.102–7.601, <jats:italic>p</jats:italic> < .001). The latter was independently associated with poor outcome (HR 2.495, 95% CI 1.192–5.222, <jats:italic>p</jats:italic> = .015).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p><jats:italic>Magnusiomyces‐</jats:italic>associated infections are often breakthrough infections. Effective treatment regimens of these infections remain to be determined, but neutrophil recovery appears to play an important role in the favourable outcome.</jats:p></jats:sec>

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