Invasive aspergillosis in patients with hematological malignancies in the Czech and Slovak republics: Fungal InfectioN Database (FIND) analysis, 2005-2009
Invasive aspergillosis in patients with hematological malignancies in the Czech and Slovak republics: Fungal InfectioN Database (FIND) analysis, 2005-2009
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DOI：
10.1016/j.ijid.2012.09.004
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发表时间：
2013-02-01
影响因子：
8.4
通讯作者：
Mayer, Jiri
中科院分区：
文献类型：
--
作者：
Racil, Zdenek;Weinbergerova, Barbora;Mayer, Jiri
目的：评价血液系统恶性肿瘤患者侵袭性曲霉病（IA）的危险因素、诊断方法和治疗结果。方法：回顾性分析2005年至2009年10个血液学中心发生的证实/可能的IA病例资料。结果：我们发现176例IA主要发生在急性白血病患者（58.5%），主要是诱导/再诱导治疗患者（39.8%）。延长中性粒细胞减少是IA最常见的危险因素（61.4%）。肺部是最常受影响的部位（93.8%），计算机断层扫描在所有发作中都发现了异常；然而，只有53.7%的患者有提示IA的发现。血清或支气管肺泡灌洗液半乳甘露聚糖（GM）检测（阳性率分别为79.1%和78.8%）在IA诊断中起关键作用。中性粒细胞计数和抗真菌预防不影响GM阳性率，但经验性治疗降低了这一比率（血清）。在IA病例中，53.2%对初始抗真菌治疗有反应。伏立康唑与棘白菌素联合治疗，无论是作为初始治疗还是挽救治疗，其疗效均不优于伏立康唑单药治疗（初始治疗p = 0.924，挽救治疗p = 0.205）。中性粒细胞恢复在初始抗真菌治疗（但不是抢救）的反应中起着重要作用。结论：我们的回顾性分析确定了关键的诊断和治疗特征，这一认识可以改善血液恶性肿瘤合并IA患者的管理。(C) 2012年由爱思唯尔有限公司代表国际传染病学会出版。
Objectives: To evaluate risk factors, diagnostic procedures, and treatment outcomes of invasive aspergillosis (IA) in patients with hematological malignancies.Methods: A retrospective analysis of data from proven/probable IA cases that occurred from 2005 to 2009 at 10 hematology centers was performed.Results: We identified 176 IA cases that mainly occurred in patients with acute leukemias (58.5%), mostly those on induction/re-induction treatments (39.8%). Prolonged neutropenia was the most frequent risk factor for IA (61.4%). The lungs were the most frequently affected site (93.8%) and computed tomography detected abnormalities in all episodes; however, only 53.7% of patients had findings suggestive of IA. Galactomannan (GM) detection in serum or bronchoalveolar lavage fluid (positive in 79.1% and 78.8% of episodes, respectively) played a crucial role in IA diagnosis. Neutrophil count and antifungal prophylaxis did not influence the GM positivity rate, but empirical therapy decreased this rate (in serum). Of the IA cases, 53.2% responded to initial antifungal therapy. The combination of voriconazole and echinocandin, even as initial or salvage therapy, did not perform better than voriconazole monotherapy (p = 0.924 for initial therapy and p = 0.205 for salvage therapy). Neutrophil recovery had a significant role in the response to initial (but not salvage) antifungal therapy.Conclusions: Our retrospective analysis identified key diagnostic and treatment characteristics, and this understanding could improve the management of hematological malignancy patients with IA. (C) 2012 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.