Revision of antifungal strategies definitions for invasive fungal infections (proven/probable/possible) in 461 patients with haematological malignancies (REDEFI-SEIFEM).
antifungal therapy
haematological neoplasms
invasive fungal infections
possible IFI
probable IFI
proven IFI
Journal
Mycoses
ISSN: 1439-0507
Titre abrégé: Mycoses
Pays: Germany
ID NLM: 8805008
Informations de publication
Date de publication:
Aug 2024
Aug 2024
Historique:
revised:
23
07
2024
received:
06
03
2024
accepted:
28
07
2024
medline:
16
8
2024
pubmed:
16
8
2024
entrez:
16
8
2024
Statut:
ppublish
Résumé
Invasive fungal infections (IFI) are a relevant cause of morbidity and mortality among patients with haematological neoplasms (HMs). Since 2002, a classification of IFI based on host factors, clinical and radiological features and mycological tests was published for research purpose. These criteria are widely used in clinical practice to identify patients at risk for IFI. The aim of the study was to evaluate the clinical applicability of EORTC/MSG 2008 criteria for the diagnosis of IFI in daily practice. This multicentre, non-interventional, observational, prospective study gathered all consecutive inpatients with HMs in which an intravenous antifungal treatment was started. Exclusion criteria were a previous or concomitant transplant procedure, outpatient status and oral antifungal therapy. EORTC/MSG 2008 criteria were used to classify patients at the beginning of antifungal therapy and at 30 days. An independent board reviewed the classification of IFI given by local clinicians at T0 and T30. The highest percentage of agreement was found for possible IFI (96%), while a lower agreement was reported for proven IFI (74%), and the highest variability was observed for probable IFI (56%). At T30, the board re-evaluation confirmed a strict agreement for possible IFI only (98%). Among 306 patients classified as possible, 156 (51%) patients showed non-typical radiological findings and 45 (15%) patients presented host factors only. In real life, the EORTC/MSG criteria can be applicable only for possible IFI. As non-typical radiological findings are reported in possible IFI, introducing a new IFI category should be considered.
Sections du résumé
BACKGROUND
BACKGROUND
Invasive fungal infections (IFI) are a relevant cause of morbidity and mortality among patients with haematological neoplasms (HMs). Since 2002, a classification of IFI based on host factors, clinical and radiological features and mycological tests was published for research purpose.
OBJECTIVES
OBJECTIVE
These criteria are widely used in clinical practice to identify patients at risk for IFI. The aim of the study was to evaluate the clinical applicability of EORTC/MSG 2008 criteria for the diagnosis of IFI in daily practice.
PATIENTS/METHODS
METHODS
This multicentre, non-interventional, observational, prospective study gathered all consecutive inpatients with HMs in which an intravenous antifungal treatment was started. Exclusion criteria were a previous or concomitant transplant procedure, outpatient status and oral antifungal therapy. EORTC/MSG 2008 criteria were used to classify patients at the beginning of antifungal therapy and at 30 days. An independent board reviewed the classification of IFI given by local clinicians at T0 and T30.
RESULTS
RESULTS
The highest percentage of agreement was found for possible IFI (96%), while a lower agreement was reported for proven IFI (74%), and the highest variability was observed for probable IFI (56%). At T30, the board re-evaluation confirmed a strict agreement for possible IFI only (98%). Among 306 patients classified as possible, 156 (51%) patients showed non-typical radiological findings and 45 (15%) patients presented host factors only.
CONCLUSIONS
CONCLUSIONS
In real life, the EORTC/MSG criteria can be applicable only for possible IFI. As non-typical radiological findings are reported in possible IFI, introducing a new IFI category should be considered.
Substances chimiques
Antifungal Agents
0
Types de publication
Journal Article
Observational Study
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13781Subventions
Organisme : GILEAD Fellowship Program 2023
Investigateurs
Cesaro Simone
(C)
Fanci Rosa
(F)
Dargenio Michela
(D)
Forghieri Fabio
(F)
Ballanti Stelvio
(B)
Cudillo Laura
(C)
Cuccaro Annarosa
(C)
Carraro Francesca
(C)
Zama Daniele
(Z)
Armiento Daniele
(A)
Garzia Maria Grazia
(GM)
Spolzino Angelica
(S)
Informations de copyright
© 2024 Wiley‐VCH GmbH. Published by John Wiley & Sons Ltd.
Références
Reuter S, Kern W, Zenz C, Kern P. Prognostic factors for invasive aspergillosis in patients with haematological malignancies. Scand J Infect Dis. 2009;41(6–7):483‐490.
Pagano L, Caira M, Candoni A, et al. Invasive aspergillosis in patients with acute myeloid leukemia: a SEIFEM‐2008 registry study. Haematologica. 2010;95(4):644‐650.
Person AK, Kontoyiannis DP, Alexander BD. Fungal infections in transplant and oncology patients. Infect Dis Clin N Am. 2010;24:439‐459.
Ullmann AJ, Aguado JM, Arikan‐Akdagli S, et al. Diagnosis and management of aspergillus diseases: executive summary of the 2017 ESCMID‐ECMM‐ERS guideline. Clin Microbiol Infect. 2018;24:e1‐e38.
Dodds‐Ashley E. Management of drug and food interactions with azole antifungal agents in transplant recipients. Pharmacotherapy. 2010;30(8):842‐854. doi:10.1592/phco.30.8.842
Roth RS, Masouridi‐Levrat S, Chalandon Y, et al. Invasive mold infections in allogeneic hematopoietic cell transplant recipients in 2020: have we made enough progress? Open Forum Infect Dis. 2021;9:ofab596.
Ascioglu S, Rex JH, de Pauw B, et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis. 2002;34:7‐14.
De Pauw B. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46(12):1813‐1821.
Donnelly JP, Chen SC, Kauffman CA, et al. Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis. 2020;71(6):1367‐1376.
Mah J, Nicholas V, Tayyar R, et al. Superior accuracy of aspergillus plasma cell‐free DNA PCR over serum galactomannan for the diagnosis of invasive aspergillosis. Clin Infect Dis. 2023;77:1282‐1290.
Bukkems LMP, van Dommelen L, Regis M, van den Heuvel E, Nieuwenhuizen L. The use of galactomannan antigen assays for the diagnosis of invasive pulmonary aspergillosis in the hematological patient: a systematic review and meta‐analysis. J Fungi (Basel). 2023;9(6):674.
Sabbah R, Korem M, Shaulov A, Aumann S, Nachmias B. Utility of galactomannan screening for early detection of invasive aspergillosis in high‐risk hemato‐oncology patients. Acta Haematol. 2023;146(5):358‐365. doi:10.1159/000531044
Siopi M, Karakatsanis S, Roumpakis C, et al. A prospective multicenter cohort surveillance study of invasive aspergillosis in patients with hematologic malignancies in Greece: impact of the revised EORTC/MSGERC 2020 criteria. J Fungi. 2021;7:27. doi:10.3390/jof7010027
Cornely OA, Maertens J, Winston DJ, et al. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med. 2007;356(4):348‐359.
Scott SA, Perry C, Mahmoudjafari Z, et al. Incidence of breakthrough fungal infections on isavuconazole prophylaxis compared to posaconazole and voriconazole. Transpl Infect Dis. 2023;25(2):e14045.
Rieger H, Lustig D, Barlow S, et al. Applicability of the EORTC/MSG criteria for IFD in clinical practice. Ann Hematol. 2015;94:847‐855.
Girmenia C, Guerrisi P, Frustaci AM, et al. New category of probable invasive pulmonary aspergillosis in haematological patients. Clin Microbiol Infect. 2012;18:990‐996. doi:10.1111/j.1469-0691.2011.03685.x
Wang SS, Kotecha RS, Bernard A, et al. Invasive fungal infections in children with acute lymphoblastic leukaemia: results from four Australian centres, 2003–2013. Pediatr Blood Cancer. 2019;66(10):e27915.