Τίτλος:
Characterization and outcome of invasive infections due to Paecilomyces variotii: Analysis of patients from the FungiScope®registry and literature reports
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Objectives: To provide a basis for clinical management decisions in Paecilomyces variotii infection. Methods: Unpublished cases of invasive P. variotii infection from the FungiScope® registry and all cases reported in the literature were analysed. Results: We identified 59 cases with P. variotii infection. Main baseline factors were presence of indwelling devices in 29 cases (49.2%), particularly peritoneal catheters (33.9%) and prosthetic heart valves (10.2%), haematological or oncological diseases in 19 (32.2%), major surgery in 11 (18.6%), and diabetes mellitus in 10 cases (16.9%). The most prevalent infection sites were peritoneum (n = 20, 33.3%) and lungs (n = 16, 27.1%). Pain and fever were frequent (n = 35, 59.3% and n = 33, 55.9%, respectively). Diagnosis was established by culture in 58 cases (98.3%). P. variotii caused breakthrough infection in 8 patients. Systemic antifungals were given in 52 patients (88.1%). Amphotericin B was administered in 39, itraconazole in 15, and posaconazole in 8 patients. Clinical isolates were frequently resistant to voriconazole, whereas the above-mentioned antifungals showed good in vitro activity. Infections of the blood and CNS caused high mortality. Overall mortality was 28.8% and death was attributed to P. variotii in 10 cases. Conclusions: P. variotii causes life-threatening infections, especially in immunocompromised and critically ill patients with indwelling devices. Patients undergoing peritoneal dialysis are at particular risk. Multidisciplinary management is paramount, including molecular techniques for diagnosis and treatment with efficacious systemic antifungals. Amphotericin B, itraconazole and posaconazole are regarded as treatments of choice. Combination with flucytosine may be considered. Surgical debridement and removal of indwelling devices facilitate favourable outcome. © 2021 The Author(s). Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.
Συγγραφείς:
Sprute, R.
Salmanton-Garciá, J.
Sal, E.
Malaj, X.
Falces-Romero, I.
Hatvani, L.
Heinemann, M.
Klimko, N.
López-Soria, L.
Meletiadis, J.
Shruti, M.
Steinmann, J.
Seidel, D.
Cornely, O.A.
Stemler, J.
Περιοδικό:
Journal of Antimicrobial Chemotherapy (JAC)
Εκδότης:
Oxford University Press
Λέξεις-κλειδιά:
amphotericin B; anidulafungin; caspofungin; echinocandin; fluconazole; flucytosine; granulocyte colony stimulating factor; isavuconazole; itraconazole; ketoconazole; posaconazole; steroid; terbinafine; voriconazole; antifungal agent; mycosis; voriconazole, adult; all cause mortality; allogeneic hematopoietic stem cell transplantation; antifungal resistance; antifungal susceptibility; antifungal therapy; Article; aspergillosis; autologous hematopoietic stem cell transplantation; bloodstream infection; Byssochlamys spectabilis; cardiovascular infection; catheter infection; central nervous system infection; chronic kidney failure; clinical outcome; coinfection; combination drug therapy; controlled study; diabetes mellitus; female; fever; fungal endocarditis; fungus culture; fungus isolation; graft versus host reaction; hematologic disease; human; human tissue; in vitro study; infection prevention; lung mycosis; major clinical study; major surgery; male; malignant neoplasm; mortality rate; nonhuman; paecilomycosis; pain; peritoneal dialysis; peritonitis; soft tissue infection; steroid therapy; systemic mycosis; systemic therapy; Byssochlamys; drug therapy; epidemiology; Paecilomyces; register, Antifungal Agents; Byssochlamys; Humans; Mycoses; Paecilomyces; Registries; Voriconazole
