Epidemiology, outcomes, and mortality predictors of invasive mold infections among transplant recipients: a 10-year, single-center experience.
Epidemiology, outcomes, and mortality predictors of invasive mold infections among transplant recipients: a 10-year, single-center experience.
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DOI：
10.1111/tid.12060
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发表时间：
2013-06
期刊：
影响因子：
--
通讯作者：
Marr KA
中科院分区：
文献类型：
--
作者：
Neofytos D;Treadway S;Ostrander D;Alonso CD;Dierberg KL;Nussenblatt V;Durand CM;Thompson CB;Marr KA
移植受者侵袭性霉菌感染（IMI）的流行病学根据地理、宿主、预防策略和诊断方法而不同。我们进行了一项回顾性观察性研究，以评估在“经典”基于培养诊断的时代（2000-2009年）所有成人造血干细胞（HSCT）和实体器官移植（SOT）接受者中已证实和可能的IMI的流行病学，使用先前的定义。2005年以后，在HSCT接受者中开始增加支气管镜检查的主动性开始前后，对流行病学进行了评估。总共有106例患者被确定为一种IMI。侵袭性曲霉病（IA）是最常见的IMI(69; 65.1%)，其次是毛霉病（9;8.5%）。同种异体造血干细胞移植受者IMI（和IA）的总发生率为3.5%（2.5%）。肺、肾、肝和心脏移植受者IMI的总发病率分别为每1000人年49、2、11和10例。支气管镜检查开始后，hla匹配非相关和单倍相同HSCT受者的IMI发生率从每年0.6%增加到3.0% （P<0.05）。同种异体造血干细胞移植、肝脏、肾脏、心脏和肺部IMI患者的12周死亡率分别为52.4%、47.1%、27.8%、16.7%和9.5%。同种异体HSCT（优势比[OR]: 0.07， P=0.007）和SOT（优势比[OR]: 0.22， P=0.05）接受IA的患者中，正常血小板计数与生存率提高相关。男性（OR: 14.4， P=0.007）和胆红素升高（OR: 5.7， P=0.04）分别是同种异体HSCT和SOT患者IA死亡率的重要预测因素。在基于培养的诊断时代，除了肺移植受者外，所有移植中观察到的IMI率都很低，死亡率相对较高。诊断侵袭性和宿主变量影响报告的IMI发病率和结果，并可能解释多中心研究中的制度差异。需要对SOT接受者的诊断进行标准化定义。
The epidemiology of invasive mold infections (IMI) in transplant recipients differs, based on geography, hosts, preventative strategies, and methods of diagnosis. We conducted a retrospective observational study to evaluate the epidemiology of proven and probable IMI, using prior definitions, among all adult hematopoietic stem cell (HSCT) and solid organ transplant (SOT) recipients in the era of “classic” culture-based diagnostics (2000–2009). Epidemiology was evaluated before and after an initiative was begun to increase bronchoscopy in HSCT recipients after 2005. In total, 106 patients with one IMI were identified. Invasive aspergillosis (IA) was the most common IMI (69; 65.1%), followed by mucormycosis (9; 8.5%). The overall rate of IMI (and IA) was 3.5% (2.5%) in allogeneic HSCT recipients. The overall incidence for IMI among lung, kidney, liver, and heart transplant recipients were 49, 2, 11, and 10 per 1000 person-years, respectively. The observed rate of IMI among HLA-matched unrelated and haploidentical HSCT recipients increased from 0.6% annually to 3.0% after bronchoscopy initiation (P<0.05). The 12-week mortality among allogeneic HSCT, liver, kidney, heart, and lung recipients with IMI was 52.4%, 47.1%, 27.8%, 16.7%, and 9.5%, respectively. Among allogeneic HSCT (odds ratio [OR]: 0.07, P=0.007) and SOT (OR: 0.22, P=0.05) recipients with IA, normal platelet count was associated with improved survival. Male gender (OR: 14.4, P=0.007) and elevated bilirubin (OR: 5.7, P=0.04) were significant predictors of mortality for allogeneic HSCT and SOT recipients with IA, respectively. During the era of culture-based diagnostics, observed rates of IMI were low among all transplants except lung transplant recipients, with relatively higher mortality rates. Diagnostic aggressiveness and host variables impact the reported incidence and outcome of IMI and likely account for institutional variability in multicenter studies. Definitions to standardize diagnoses among SOT recipients are needed.
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DOI：
10.1086/591458
发表时间：
2008-10-15
期刊：
The Journal of infectious diseases
影响因子：
--
作者：
Perkhofer S;Kehrel BE;Dierich MP;Donnelly JP;Nussbaumer W;Hofmann J;von Eiff C;Lass-Flörl C
通讯作者：
Lass-Flörl C
DOI：
10.1086/591969
发表时间：
2008-10-15
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Garcia-Vidal C;Upton A;Kirby KA;Marr KA
通讯作者：
Marr KA
DOI：
10.1007/bf01967060
发表时间：
1992-02-01
影响因子：
4.5
作者：
BODEY, G;BUELTMANN, B;VANTWOUT, J
通讯作者：
VANTWOUT, J
影响因子：
3.5
作者：
Tarrand, JJ;Lichterfeld, M;Kontoyiannis, DP
通讯作者：
Kontoyiannis, DP
影响因子：
20.3
作者：
Marr, KA;Carter, RA;Corey, L
通讯作者：
Corey, L