Invasive aspergillosis in adult patients in Australia and New Zealand: 2017–2020Research in context

Shio Yen Tio; Sharon C.-A. Chen; Kate Hamilton; Christopher H. Heath; Alyssa Pradhan; Arthur J. Morris; Tony M. Korman; Orla Morrissey; Catriona L. Halliday; Sarah Kidd; Timothy Spelman; Nadiya Brell; Brendan McMullan; Julia E. Clark; Katerina Mitsakos; Robyn P. Hardiman; Phoebe Williams; Anita J. Campbell; Justin Beardsley; Sebastiaan Van Hal; Michelle K. Yong; Leon J. Worth; Monica A. Slavin

The Lancet Regional Health. Western Pacific (Nov 2023)

Invasive aspergillosis in adult patients in Australia and New Zealand: 2017–2020Research in context

Shio Yen Tio,
Sharon C.-A. Chen,
Kate Hamilton,
Christopher H. Heath,
Alyssa Pradhan,
Arthur J. Morris,
Tony M. Korman,
Orla Morrissey,
Catriona L. Halliday,
Sarah Kidd,
Timothy Spelman,
Nadiya Brell,
Brendan McMullan,
Julia E. Clark,
Katerina Mitsakos,
Robyn P. Hardiman,
Phoebe Williams,
Anita J. Campbell,
Justin Beardsley,
Sebastiaan Van Hal,
Michelle K. Yong,
Leon J. Worth,
Monica A. Slavin

Affiliations

Shio Yen Tio: Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia; National Centre for Infections in Cancer, Melbourne, Australia; Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia; Corresponding author. Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia.
Sharon C.-A. Chen: Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia; School of Medicine, University of Sydney, Australia
Kate Hamilton: Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia
Christopher H. Heath: Department of Microbiology, PathWest Laboratory Medicine, Murdoch, Western Australia, Australia; Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Department of Medicine, University of Western Australia, Crawley, Western Australia, Australia
Alyssa Pradhan: Prince of Wales Hospital, Southeast Sydney LHD, NSW Health Pathology, Australia; School of Medicine, University of Sydney, Australia
Arthur J. Morris: Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand
Tony M. Korman: Monash University and Monash Health, Clayton, Victoria, Australia
Orla Morrissey: Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
Catriona L. Halliday: Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia; School of Medicine, University of Sydney, Australia
Sarah Kidd: National Mycology Reference Centre, Microbiology & Infectious Diseases, SA Pathology, Adelaide, South Australia, Australia
Timothy Spelman: Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
Nadiya Brell: Prince of Wales Hospital, Southeast Sydney LHD, NSW Health Pathology, Australia; University of New South Wales, Australia
Brendan McMullan: Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Australia
Julia E. Clark: Infection Management Service, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane 4101, Australia; School of Clinical Medicine, CHQCU, University of Queensland, Australia
Katerina Mitsakos: Department of Infectious Disease and Microbiology, Royal North Shore Hospital, Sydney, Australia
Robyn P. Hardiman: Department of Infectious Disease and Microbiology, Royal North Shore Hospital, Sydney, Australia
Phoebe Williams: Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Australia; School of Public Health, Faculty of Medicine, The University of Sydney, Australia
Anita J. Campbell: Department of Infectious Diseases, Perth Children’s Hospital, Western Australia, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Western Australia, Australia
Justin Beardsley: University of Sydney Infectious Disease Institute, Australia; Westmead Hospital, Western Sydney LHD, NSW Health, Australia; Westmead Institute for Medical Research, Australia
Sebastiaan Van Hal: School of Medicine, University of Sydney, Australia; Department of Infectious Diseases and Microbiology Royal Prince Alfred Hospital, Australia
Michelle K. Yong: Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia; National Centre for Infections in Cancer, Melbourne, Australia; Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
Leon J. Worth: Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia; National Centre for Infections in Cancer, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
Monica A. Slavin: Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia; National Centre for Infections in Cancer, Melbourne, Australia; Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia

Journal volume & issue: Vol. 40
p. 100888

Abstract

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Summary: Background: New and emerging risks for invasive aspergillosis (IA) bring the need for contemporary analyses of the epidemiology and outcomes of IA, in order to improve clinical practice. Methods: The study was a retrospective, multicenter, cohort design of proven and probable IA in adults from 10 Australasian tertiary centres (January 2017–December 2020). Descriptive analyses were used to report patients’ demographics, predisposing factors, mycological characteristics, diagnosis and management. Accelerated failure-time model was employed to determine factor(s) associated with 90-day all-cause mortality (ACM). Findings: Of 382 IA episodes, 221 (in 221 patients) fulfilled inclusion criteria – 53 proven and 168 probable IA. Median patient age was 61 years (IQR 51–69). Patients with haematologic malignancies (HM) comprised 49.8% of cases. Fifteen patients (6.8%) had no pre-specified immunosuppression and eleven patients (5.0%) had no documented comorbidity. Only 30% of patients had neutropenia. Of 170 isolates identified, 40 (23.5%) were identified as non-Aspergillus fumigatus species complex. Azole-resistance was present in 3/46 (6.5%) of A. fumigatus sensu stricto isolates. Ninety-day ACM was 30.3%. HM (HR 1.90; 95% CI 1.04–3.46, p = 0.036) and ICU admission (HR 4.89; 95% CI 2.93–8.17, p < 0.001) but not neutropenia (HR 1.45; 95% CI 0.88–2.39, p = 0.135) were associated with mortality. Chronic kidney disease was also a significant predictor of death in the HM subgroup (HR 3.94; 95% CI 1.15–13.44, p = 0.028). Interpretation: IA is identified in high number of patients with mild/no immunosuppression in our study. The relatively high proportion of non-A. fumigatus species complex isolates and 6.5% azole-resistance rate amongst A. fumigatus sensu stricto necessitates accurate species identification and susceptibility testing for optimal patient outcomes. Funding: This work is unfunded. All authors’ financial disclosures are listed in detail at the end of the manuscript.

Published in The Lancet Regional Health. Western Pacific

ISSN: 2666-6065 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Public aspects of medicine
Website: https://www.thelancet.com/journals/lanwpc/home

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