Prospective Surveillance for Invasive Fungal Infections in Hematopoietic Stem Cell Transplant Recipients, 2001-2006: Overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database
Prospective Surveillance for Invasive Fungal Infections in Hematopoietic Stem Cell Transplant Recipients, 2001-2006: Overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database
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DOI：
10.1086/651263
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发表时间：
2010-04-15
影响因子：
11.8
通讯作者：
Pappas, Peter G.
中科院分区：
文献类型：
--
作者：
Kontoyiannis, Dimitrios P.;Marr, Kieren A.;Pappas, Peter G.
背景侵袭性真菌感染（IFIs）是造血干细胞移植（HSCT）受者死亡的主要原因，其发病率和流行病学主要来自单中心回顾性研究。移植相关感染监测网络是一个由23家美国移植中心组成的网络，前瞻性招募了2001年3月至2006年3月期间发生经证实和可能的IFIs的HSCT受者。我们收集了每个研究中心进行的所有HSCT的分母数据以及每个IFI病例的临床、诊断和结局信息。为了估计IFI的趋势，我们计算了9个连续亚群中12个月的累积发病率。我们在875例HSCT受者中确定了983例IFs。患者的中位年龄为49岁; 60%为男性。侵袭性曲霉病（43%）、侵袭性念珠菌病（28%）和真菌病（8%）是最常见的IFIs。分别有59%和61%的IFIs在中性粒细胞减少和移植物抗宿主病的60天内被识别。HSCT后念珠菌病和曲霉病的中位发病时间分别为61天和99天。在2001年3月至2005年9月期间接受首次移植的16，200名HSCT受者中，并随访至2006年3月，我们在639人中确定了718个IFIs。基于首次IFI，10个月的累积发生率为：匹配的非相关同种异体移植7.7例/100例移植，错配的相关同种异体移植8.1例/100例移植，匹配的相关同种异体移植5.8例/100例移植，自体造血干细胞移植1.2例/100例移植。在这项对HSCT受者IFIs的国家前瞻性监测研究中，曲霉病的累积发病率最高，其次是念珠菌病。了解国际金融机构的流行病学趋势和负担可能会导致改善管理策略和研究设计。
Background. The incidence and epidemiology of invasive fungal infections (IFIs), a leading cause of death among hematopoeitic stem cell transplant (HSCT) recipients, are derived mainly from single-institution retrospective studies.Methods. The Transplant Associated Infections Surveillance Network, a network of 23 US transplant centers, prospectively enrolled HSCT recipients with proven and probable IFIs occurring between March 2001 and March 2006. We collected denominator data on all HSCTs preformed at each site and clinical, diagnostic, and outcome information for each IFI case. To estimate trends in IFI, we calculated the 12-month cumulative incidence among 9 sequential subcohorts.Results. We identified 983 IFIs among 875 HSCT recipients. The median age of the patients was 49 years; 60% were male. Invasive aspergillosis (43%), invasive candidiasis (28%), and zygomycosis (8%) were the most common IFIs. Fifty-nine percent and 61% of IFIs were recognized within 60 days of neutropenia and graft-versus-host disease, respectively. Median onset of candidiasis and aspergillosis after HSCT was 61 days and 99 days, respectively. Within a cohort of 16,200 HSCT recipients who received their first transplants between March 2001 and September 2005 and were followed up through March 2006, we identified 718 IFIs in 639 persons. Twelve-month cumulative incidences, based on the first IFI, were 7.7 cases per 100 transplants for matched unrelated allogeneic, 8.1 cases per 100 transplants for mismatched-related allogeneic, 5.8 cases per 100 transplants for matched-related allogeneic, and 1.2 cases per 100 transplants for autologous HSCT.Conclusions. In this national prospective surveillance study of IFIs in HSCT recipients, the cumulative incidence was highest for aspergillosis, followed by candidiasis. Understanding the epidemiologic trends and burden of IFIs may lead to improved management strategies and study design.