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1. Fungaemia in haematological malignancies: SEIFEM-2015 survey

Author

Criscuolo, M., Marchesi, F., Candoni, A., Cattaneo, C., Nosari, A., Veggia, B., Verga, L., Fracchiolla, N., Vianelli, N., Del Principe, M. I., Picardi, M., Tumbarello, M., Aversa, F., Busca, A., Pagano, L., Dragonetti, G., Ballanti, S., Delia, M., Nadali, G., Sciume, M., Castagnola, C., Ferrari, A., Mancini, V., Decembrino, N., Spolzino, A., Iovino, L., Martino, B., Vacca, A., Calore, E., Fanci, R., Lessi, F., Vallero, S., Zama, D., Cesaro, S., De Paolis, M. R., Facchini, L., Muggeo, P., Offidani, M., Perruccio, K., Russo, D., Criscuolo M, Marchesi F, Candoni A, Cattaneo C, Nosari A, Veggia B, Verga L, Fracchiolla N, Vianelli N, Del Principe MI, Picardi M, Tumbarello M, Aversa F, Busca A, Pagano L, SEIFEM Group: Giulia Dragonetti, Stelvio Ballanti, Mario Delia, Gianpaolo Nadali, Sciumè M, Castagnola C, Ferrari A, Mancini V, Decembrino N, Spolzino A, Iovino L, Martino B, Vacca A, Calore E, Fanci R, Lessi F, Vallero S, Zama D, Cesaro S, De Paolis M, Facchini L, Muggeo P, Offidani M, Perruccio K, Russo D., Criscuolo, Marianna, Marchesi, Francesco, Candoni, Anna, Cattaneo, Chiara, Nosari, Annamaria, Veggia, Barbara, Verga, Luisa, Fracchiolla, Nicola, Vianelli, Nicola, Del Principe, Maria Ilaria, Picardi, Marco, Tumbarello, Mario, Aversa, Franco, Busca, Alessandro, and Pagano, Livio

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Clinical Biochemistry, Prevalence, 030204 cardiovascular system & hematology, Biochemistry, Young Adult, 03 medical and health sciences, acute leukaemias, candidemia, fungaemia, 0302 clinical medicine, Risk Factors, Yeasts, Internal medicine, acute leukemias, Epidemiology, Fungemia, Hematological malignancies, medicine, Aged, Candidemia, Child, Female, Fungemia, Hematologic Neoplasms, Humans, Italy, Middle Aged, Prognosis, Retrospective Studies, acute leukemia, 030212 general & internal medicine, Cause of death, Hematology, business.industry, Septic shock, Mortality rate, General Medicine, bacterial infections and mycoses, medicine.disease, Settore MED/15 - MALATTIE DEL SANGUE, fungemia, business, Central venous catheter
Abstract

BACKGROUND: Fungal infections are still a relevant challenge for clinicians involved in the cure of patients with cancer. We retrospectively reviewed charts of hospitalized patients with hematological malignancies (HMs), in which a documented fungemia was diagnosed between January 2011 and December 2015 at 28 adult and 6 pediatric Italian Hematology Departments. METHODS: During the study period we recorded 215 fungal blood stream infections (BSI). Microbiological analyses documented that BSI was due to molds in 17 patients (8%) and yeasts in 198 patients (92%), being Candida spp identified in 174 patients (81%). RESULTS: Mortality rates were 70% and 39% for mold and yeast infections, respectively. Infection was the main cause of death in 53% of the mold and 18% of the yeast groups. At the multivariate analysis, ECOG ≥2 and septic shock were significantly associated with increased mortality, and removal of CVC survival was found to be protective. When considering patients with candidemia only, ECOG >2 and removal of CVC were statistically associated with overall mortality. CONCLUSIONS: Although candidemia represents a group of BSI with a good prognosis, its risk factors largely overlap with those identified for all fungemias, even though the candidemia-related mortality is lower when compared to other fungal BSI. Management of fungal BSI is still a complex issue, in which both patients and disease characteristics should be focused to address a personalized approach. This article is protected by copyright. All rights reserved.

Published
2019
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2. Pre-chemotherapy risk factors for invasive fungal diseases: prospective analysis of 1,192 patients with newly diagnosed acute myeloid leukemia (SEIFEM 2010-a multicenter study)

Author

Caira, M., Candoni, A., Verga, L., Busca, A., Delia, M., Nosari, A., Caramatti, C., Castagnola, C., Cattaneo, C., Fanci, R., Chierichini, A., Melillo, L., Mitra, M. E., Picardi, M., Potenza, L., Salutari, P., Vianelli, N., Facchini, L., Cesarini, M., De Paolis, M. R., Di Blasi, R., Farina, F., Venditti, A., Ferrari, A., Garzia, M., Gasbarrino, C., Invernizzi, R., Lessi, F., Manna, A., Martino, B., Nadali, G., Offidani, M., Paris, L., Pavone, V., Rossi, G., Spadea, A., Specchia, G., Trecarichi, E. M., Vacca, A., Cesaro, S., Perriello, V., Aversa, F., Tumbarello, M., Pagano, L., Ragionieri, R., Orsola Malpighi, O. S., Antoniazzi, F., Storti, S., Luppi, M., Pagliuca, S., Rossetti, E., Da Vià, M., Di Caprio, L., Majolino, I., Cascavilla, N., Turri, G., Fanin, Renato, Sorveglianza Epidemiologica Infezioni Fungine in Emopatie Maligne, Caira, Morena, Candoni, Anna, Verga, Luisa, Busca, Alessandro, Delia, Mario, Nosari, Annamaria, Caramatti, Cecilia, Castagnola, Carlo, Cattaneo, Chiara, Fanci, Rosa, Chierichini, Anna, Melillo, Lorella, Mitra, Maria Enza, Picardi, Marco, Potenza, Leonardo, Salutari, Prassede, Vianelli, Nicola, Facchini, Luca, Cesarini, Monica, De Paolis, Maria Rosaria, Di Blasi, Roberta, Farina, Francesca, Venditti, Adriano, Ferrari, Antonella, Garzia, Mariagrazia, Gasbarrino, Cristina, Invernizzi, Rosangela, Lessi, Federica, Manna, Annunziata, Martino, Bruno, Nadali, Gianpaolo, Offidani, Massimo, Paris, Laura, Pavone, Vincenzo, Rossi, Giuseppe, Spadea, Antonio, Specchia, Giorgina, Trecarichi, Enrico Maria, Vacca, Adriana, Cesaro, Simone, Perriello, Vincenzo, Aversa, Franco, Tumbarello, Mario, and Pagano, Livio

Subjects
Myeloid, Male, Antifungal Agents, invasive fungal diseases, Mycose, Risk Factors, Epidemiology, Antineoplastic Combined Chemotherapy Protocols, Antifungal Agent, Prospective Studies, Prospective cohort study, Univariate analysis, leukemia, Myeloid leukemia, Hematology, Environmental exposure, Articles, Middle Aged, Prognosis, Survival Rate, Leukemia, Leukemia, Myeloid, Acute, Female, Case-Control Studie, Human, Adult, medicine.medical_specialty, Prognosi, risk factors, acute myeloid leukemia, Neutropenia, Acute, Settore MED/17 - MALATTIE INFETTIVE, Aged, Case-Control Studies, Follow-Up Studies, Humans, Mycoses, Neoplasm Staging, Immunocompromised Host, Follow-Up Studie, Internal medicine, medicine, Antineoplastic Combined Chemotherapy Protocol, Performance status, business.industry, Risk Factor, medicine.disease, Surgery, Prospective Studie, Settore MED/15 - MALATTIE DEL SANGUE, Fungal Disease, business
Abstract

Correct definition of the level of risk of invasive fungal infections is the first step in improving the targeting of preventive strategies. We investigated the potential relationship between pre-hospitalization exposure to sources of fungi and the development of invasive fungal infections in adult patients with newly diagnosed acute myeloid leukemia after their first course of chemotherapy. From January 2010 to April 2012, all consecutive acute myeloid leukemia patients in 33 Italian centers were prospectively registered. Upon first admission, information about possible pre-chemotherapy risk factors and environmental exposure was collected. We recorded data regarding comorbid conditions, employment, hygienic habits, working and living environment, personal habits, hobbies, and pets. All invasive fungal infections occurring within 30 days after the first course of chemotherapy were recorded. Of the 1,192 patients enrolled in this study, 881 received intensive chemotherapy and were included in the present analysis. Of these, 214 developed an invasive fungal infection, including 77 proven/probable cases (8.7%). Of these 77 cases, 54 were proven/probable invasive mold infections (6.1%) and 23 were proven yeast infections (2.6%). Upon univariate analysis, a significant association was found between invasive mold infections and age, performance status, diabetes, chronic obstructive pulmonary disease, smoking, cocaine use, job, hobbies, and a recent house renovation. Higher body weight resulted in a reduced risk of invasive mold infections. Multivariate analysis confirmed the role of performance status, job, body weight, chronic obstructive pulmonary disease, and house renovation. In conclusion, several hospital-independent variables could potentially influence the onset of invasive mold infections in patients with acute myeloid leukemia. Investigation of these factors upon first admission may help to define a patient's risk category and improve targeted prophylactic strategies. (Clinicaltrial.gov: NCT01315925)

Published
2015

3. COVID-19 severity and mortality in patients with CLL: an update of the international ERIC and Campus CLL study

Author

Ellen van der Spek, Emili Montserrat, Talha Munir, Paolo Ghia, Shaimaa El-Ashwah, Andreas Glenthøj, Viola Maria Popov, Sanne H. Tonino, Ann Janssens, Michel van Gelder, Lara Malerba, Rocío García-Serra, Alberto Lopez-Garcia, Juan-Gonzalo Correa, Christos Demosthenous, Idanna Innocenti, Maria Papaioannou, Lydia Scarfò, Antonio Cuneo, Francesca Romana Mauro, Sabina Kersting, Robin Foà, David Donaldson, Livio Trentin, Roberta Murru, Panagiotis Baliakas, Marina Motta, Deepesh Lad, Yervand K Hakobyan, Paolo Sportoletti, Lucrecia Yáñez San Segundo, Alicia Enrico, Elżbieta Kalicińska, Ewa Wasik-Szczepanek, Martin Spacek, Tamar Tadmor, Enrico Lista, Roel van Kampen, Lorella Orsucci, Michael Doubek, Yair Herishanu, Blanca Espinet, Jose Angel Hernandez-Rivas, Inga Piskunova, Ozren Jakšić, Georgios Karakatsoulis, Tomasz Wróbel, Oana Stanca, Luca Laurenti, Martin Andres, Roberto Marasca, Mark-David Levin, Giovanni Del Poeta, Miguel Arturo Pavlovsky, Maria Dimou, Monia Marchetti, Ivana Milosevic, Gianluigi Reda, Tobias Herold, David Allsup, Raul Cordoba, Andrea Visentin, Maria Gomes da Silva, Angela Ferrari, Antonella Capasso, Juan Marquet, Francesca Maria Quaglia, Candida Vitale, Mattias Mattsson, Marta Coscia, Moritz Fürstenau, Lucia Farina, Niki Stavroyianni, Marta Morawska, Arnon P. Kater, Mónica Baile, Gevorg Saghumyan, Carolina Cuéllar-García, Jacopo Olivieri, Darko Antic, Raquel Nunes Rodrigues, Alejandro Alonso Cabrero, Henrik Frederiksen, Alessandro Rambaldi, Marzia Varettoni, Amit Shrestha, Оlga B Kalashnikova, Thomas Chatzikonstantinou, José A. García-Marco, Martin Simkovic, Linda Katharina Karlsson, Odit Gutwein, Mohamed A. Yassin, Rosa Ruchlemer, Eva Gimeno, Kristian Qvist, Fatima Miras, Gilad Itchaki, Maria Rosaria De Paolis, Maria Efstathopoulou, Doreen te Raa, Barbara Eichhorst, Dominique Bron, Jorge Labrador, Gian Matteo Rigolin, Myriam Foglietta, Massimo Gentile, Sofia Chatzileontiadou, Carsten Utoft Niemann, Anargyros Kapetanakis, Kostas Stamatopoulos, Lorenzo De Paoli, Giulia Quaresmini, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Interne Geneeskunde, MUMC+: MA Hematologie (9), Chatzikonstantinou, T., Kapetanakis, A., Scarfo, L., Karakatsoulis, G., Allsup, D., Cabrero, A. A., Andres, M., Antic, D., Baile, M., Baliakas, P., Bron, D., Capasso, A., Chatzileontiadou, S., Cordoba, R., Correa, J. -G., Cuellar-Garcia, C., De Paoli, L., De Paolis, M. R., Del Poeta, G., Demosthenous, C., Dimou, M., Donaldson, D., Doubek, M., Efstathopoulou, M., Eichhorst, B., El-Ashwah, S., Enrico, A., Espinet, B., Farina, L., Ferrari, A., Foglietta, M., Frederiksen, H., Furstenau, M., Garcia-Marco, J. A., Garcia-Serra, R., Gentile, M., Gimeno, E., Glenthoj, A., Gomes da Silva, M., Gutwein, O., Hakobyan, Y. K., Herishanu, Y., Hernandez-Rivas, J. A., Herold, T., Innocenti, I., Itchaki, G., Jaksic, O., Janssens, A., Kalashnikova, Оb., Kalicinska, E., Karlsson, L. K., Kater, A. P., Kersting, S., Labrador, J., Lad, D., Laurenti, L., Levin, M. -D., Lista, E., Lopez-Garcia, A., Malerba, L., Marasca, R., Marchetti, M., Marquet, J., Mattsson, M., Mauro, F. R., Milosevic, I., Miras, F., Morawska, M., Motta, M., Munir, T., Murru, R., Niemann, C. U., Rodrigues, R. N., Olivieri, J., Orsucci, L., Papaioannou, M., Pavlovsky, M. A., Piskunova, I., Popov, V. M., Quaglia, F. M., Quaresmini, G., Qvist, K., Reda, G., Rigolin, G. M., Ruchlemer, R., Saghumyan, G., Shrestha, A., Simkovic, M., Spacek, M., Sportoletti, P., Stanca, O., Stavroyianni, N., Tadmor, T., Te Raa, D., Tonino, S. H., Trentin, L., Van Der Spek, E., van Gelder, M., van Kampen, R., Varettoni, M., Visentin, A., Vitale, C., Wasik-Szczepanek, E., Wrobel, T., San Segundo, L. Y., Yassin, M., Coscia, M., Rambaldi, A., Montserrat, E., Foa, R., Cuneo, A., Stamatopoulos, K., Ghia, P., Experimental Immunology, Clinical Haematology, AII - Cancer immunology, and CCA - Cancer Treatment and Quality of Life

Subjects
Chronic lymphocytic leukaemia, Cancer Research, medicine.medical_specialty, COVID-19 Vaccines, Coronavirus disease 2019 (COVID-19), Epidemiology, medicine.medical_treatment, Chronic lymphocytic leukemia, CLL, COVID-19, 610 Medicine & health, Disease, Lower risk, COVID-19 (Malaltia), Severity of Illness Index, Article, NO, law.invention, Risk Factors, law, Internal medicine, Case fatality rate, Mortalitat, medicine, Humans, Hematologi, Chronic, Mortality, Science & Technology, Leukemia, SARS-CoV-2, business.industry, Vaccination, B-Cell, Leucèmia, COVID-19, Immunosuppression, Hematology, Prognosis, medicine.disease, Leukemia, Lymphocytic, Chronic, B-Cell, Survival Analysis, Intensive care unit, Lymphocytic, Oncology, business, Life Sciences & Biomedicine
Abstract

Patients with chronic lymphocytic leukemia (CLL) may be more susceptible to Coronavirus disease 2019 (COVID-19) due to age, disease, and treatment-related immunosuppression. We aimed to assess risk factors of outcome and elucidate the impact of CLL-directed treatments on the course of COVID-19. We conducted a retrospective, international study, collectively including 941 patients with CLL and confirmed COVID-19. Data from the beginning of the pandemic until March 16, 2021, were collected from 91 centers. The risk factors of case fatality rate (CFR), disease severity, and overall survival (OS) were investigated. OS analysis was restricted to patients with severe COVID-19 (definition: hospitalization with need of oxygen or admission into an intensive care unit). CFR in patients with severe COVID-19 was 38.4%. OS was inferior for patients in all treatment categories compared to untreated (p

Published
2021
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4. COVID-19 severity and mortality in patients with chronic lymphocytic leukemia: a joint study by ERIC, the European Research Initiative on CLL, and CLL Campus

Author

Tobias Herold, Martin Andres, Gimena Dos Santos, Livio Trentin, Monia Marchetti, Antonio Cuneo, Robin Foà, Vladimir Strugov, Sunil Iyengar, Ozren Jakšić, Mark-David Levin, Angela Ferrari, Francesca Romana Mauro, Candida Vitale, Martin Spacek, Olga Kalashnikova, Eugene Nikitin, Ann Janssens, Constantine S. Tam, Julio Delgado, Maria Papaioannou, Barbara Pocali, Davide Rossi, Marina Motta, Niki Stavroyianni, Myriam Foglietta, Alicia Enrico, Carolina Cuéllar-García, Lara Malerba, Mónica Baile, Lydia Scarfò, Ellen van der Spek, Paolo Sportoletti, Maria Rosaria De Paolis, Mihnea Zdrenghea, Macarena Ortiz Pareja, Annalisa Chiarenza, Sabina Kersting, Fatima Miras, Yair Herishanu, Emili Montserrat, Marta Coscia, Giuseppe Rossi, Jose Angel Hernandez-Rivas, Carsten Utoft Niemann, Alessandro Rambaldi, Amit Shrestha, Roberto Marasca, Rosa Ruchlemer, Marzia Varettoni, Dominique Bron, Juan Marquet, Eva Gimeno, Viola Maria Popov, Massimo Gentile, Mohamed A. Yassin, Kostas Stamatopoulos, Lorenzo De Paoli, Thomas Chatzikonstantinou, Giulia Quaresmini, Luca Laurenti, Lucia Farina, Arnon P. Kater, Nimish Shah, Elisabeth Vandenberghe, José A. García-Marco, Oana Stanca, Giovanni Del Poeta, Martin Simkovic, Yervand K Hakobyan, Enrico Lista, Michael Doubek, Gilad Itchaki, Talha Munir, Paolo Ghia, Ewa Wasik-Szczepanek, Gianluigi Reda, Francesca Maria Quaglia, Maria Dimou, Gábor Barna, Lorella Orsucci, Gian Matteo Rigolin, Scarfo', L., Chatzikonstantinou, T., Rigolin, G. M., Quaresmini, G., Motta, M., Vitale, C., Garcia-Marco, J. A., Hernandez-Rivas, J. A., Miras, F., Baile, M., Marquet, J., Niemann, C. U., Reda, G., Munir, T., Gimeno, E., Marchetti, M., Quaglia, F. M., Varettoni, M., Delgado, J., Iyengar, S., Janssens, A., Marasca, R., Ferrari, A., Cuellar-Garcia, C., Itchaki, G., Spacek, M., De Paoli, L., Laurenti, L., Levin, M. -D., Lista, E., Mauro, F. R., Simkovic, M., Van Der Spek, E., Vandenberghe, E., Trentin, L., Wasik-Szczepanek, E., Ruchlemer, R., Bron, D., De Paolis, M. R., Del Poeta, G., Farina, L., Foglietta, M., Gentile, M., Herishanu, Y., Herold, T., Jaksic, O., Kater, A. P., Kersting, S., Malerba, L., Orsucci, L., Popov, V. M., Sportoletti, P., Yassin, M., Pocali, B., Barna, G., Chiarenza, A., dos Santos, G., Nikitin, E., Andres, M., Dimou, M., Doubek, M., Enrico, A., Hakobyan, Y., Kalashnikova, O., Ortiz Pareja, M., Papaioannou, M., Rossi, D., Shah, N., Shrestha, A., Stanca, O., Stavroyianni, N., Strugov, V., Tam, C., Zdrenghea, M., Coscia, M., Stamatopoulos, K., Rossi, G., Rambaldi, A., Montserrat, E., Foa, R., Cuneo, A., Ghia, P., Experimental Immunology, Clinical Haematology, and CCA - Cancer Treatment and Quality of Life

Subjects
0301 basic medicine, Male, Chronic lymphocytic leukaemia, Cancer Research, Chronic Lymphocytic Leukemia, COVID-19, Chronic lymphocytic leukemia, Comorbidity, Severity of Illness Index, chemistry.chemical_compound, 0302 clinical medicine, Piperidines, Obinutuzumab, Surveys and Questionnaires, hemic and lymphatic diseases, 80 and over, Viral, Chronic, 610 Medicine & health, Immunodeficiency, Aged, 80 and over, Leukemia, Mortality rate, Age Factors, Hematology, Middle Aged, Prognosis, Lymphocytic, Oncology, 030220 oncology & carcinogenesis, Infectious diseases, Female, Coronavirus Infections, medicine.drug, Bendamustine, medicine.medical_specialty, Pneumonia, Viral, Antineoplastic Agents, Article, NO, 03 medical and health sciences, Betacoronavirus, Internal medicine, Severity of illness, medicine, Humans, Chronic Lymphocytic Leukemia, Pandemics, Protein Kinase Inhibitors, Aged, Retrospective Studies, SARS-CoV-2, Venetoclax, business.industry, Adenine, B-Cell, COVID-19, Odds ratio, Pneumonia, medicine.disease, Leukemia, Lymphocytic, Chronic, B-Cell, Settore MED/15 - MALATTIE DEL SANGUE, 030104 developmental biology, Pyrazoles, Pyrimidines, chemistry, business
Abstract

Chronic lymphocytic leukemia (CLL) is a disease of the elderly, characterized by immunodeficiency. Hence, patients with CLL might be considered more susceptible to severe complications from COVID-19. We undertook this retrospective international multicenter study to characterize the course of COVID-19 in patients with CLL and identify potential predictors of outcome. Of 190 patients with CLL and confirmed COVID-19 diagnosed between 28/03/2020 and 22/05/2020, 151 (79%) presented with severe COVID-19 (need of oxygen and/or intensive care admission). Severe COVID-19 was associated with more advanced age (≥65 years) (odds ratio 3.72 [95% CI 1.79–7.71]). Only 60 patients (39.7%) with severe COVID-19 were receiving or had recent (≤12 months) treatment for CLL at the time of COVID-19 versus 30/39 (76.9%) patients with mild disease. Hospitalization rate for severe COVID-19 was lower (p < 0.05) for patients on ibrutinib versus those on other regimens or off treatment. Of 151 patients with severe disease, 55 (36.4%) succumbed versus only 1/38 (2.6%) with mild disease; age and comorbidities did not impact on mortality. In CLL, (1) COVID-19 severity increases with age; (2) antileukemic treatment (particularly BTK inhibitors) appears to exert a protective effect; (3) age and comorbidities did not impact on mortality, alluding to a relevant role of CLL and immunodeficiency.

Published
2020

5. Candidaemia in haematological malignancy patients from a SEIFEM study: Epidemiological patterns according to antifungal prophylaxis

Author

Posteraro, Brunella, De Carolis, Elena, Criscuolo, Marianna, Ballanti, Stelvio, De Angelis, Giulia, Del Principe, Maria Ilaria, Delia, Mario, Fracchiolla, Nicola, Marchesi, Francesco, Nadali, Gianpaolo, Picardi, Marco, Piccioni, Anna Lina, Verga, Luisa, Candoni, Anna, Busca, Alessandro, Sanguinetti, Maurizio, Pagano, Livio, Decembrino, Nunzia, Mario, Delia, Paola, Muggeo, Marta, Stanzani, Chiara, Cattaneo, Russo, Domenico, Adriana, Vacca, Rosa, Fanci, Maria, Rosaria, Nicola, Fracchiolla, Valentina, Mancini, Luisa, Verga, Marco, Picardi, Federica, Lessi, Stelvio, Ballanti, Elena, Rossetti, Luca, Facchini, Marianna, Criscuolo, Giulia, Dragonetti, Livio, Pagano, Maria Ilaria Del Principe, Anna Lina Piccioni, Antonella, Ferrari, Francesco, Marchesi, Stefano, Vallero, Alessandro, Busca, Anna, Candoni, Gianpaolo, Nadali, Posteraro, B., De Carolis, E., Criscuolo, M., Ballanti, S., De Angelis, G., Del Principe, M. I., Delia, M., Fracchiolla, N., Marchesi, F., Nadali, G., Picardi, M., Piccioni, A. L., Verga, L., Candoni, A., Busca, A., Sanguinetti, M., Pagano, L., Muggeo, P., Stanzani, M., Cattaneo, C., Russo, D., Vacca, A., Fanci, R., De Paolis, M. R., Mancini, V., Lessi, F., Rossetti, E., Decembrino, N., Facchini, L., Dragonetti, G., Ferrari, A., and Vallero, S.

Subjects
0301 basic medicine, Antifungal, Adult, Male, medicine.medical_specialty, Posaconazole, epidemiological study, Antifungal Agents, medicine.drug_class, 030106 microbiology, SEIFEM, Dermatology, Microbial Sensitivity Tests, Chemoprevention, Settore MED/07 - MICROBIOLOGIA E MICROBIOLOGIA CLINICA, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Drug Resistance, Fungal, antifungal prophylaxis, Internal medicine, Epidemiology, medicine, antifungal prophylaxi, Humans, candidaemia, haematological malignancy, Aged, Candida, Retrospective Studies, Hematology, business.industry, Incidence (epidemiology), Candidemia, General Medicine, Middle Aged, Settore MED/15, Corpus albicans, Infectious Diseases, Italy, Hematologic Neoplasms, Female, business, Haematological malignancy, Fluconazole, medicine.drug
Abstract

Background: Candidaemia is an important infectious complication for haematological malignancy patients. Antifungal prophylaxis reduces the incidence of candidaemia but may be associated with breakthrough candidaemia. Objective: To analyse the Candida species’ distribution and relative antifungal susceptibility profiles of candidaemia episodes in relation to the use of antifungal prophylaxis among Italian SEIFEM haematology centres. Methodology: This multicentre retrospective observational SEIFEM study included 133 single-species candidaemia episodes of haematological malignancy patients for whom antifungal susceptibility testing results of blood Candida isolates were available between 2011 and 2015. Each participating centre provided both clinical and microbiological data. Results: Non-Candida albicans Candida (NCAC) species were the mostly isolated species (89, 66.9%), which accounted for C parapsilosis (35, 26.3%), C glabrata (16, 12.0%), C krusei (14, 10.5%), C tropicalis (13, 9.8%) and uncommon species (11, 8.3%). C albicans caused the remaining 44 (33.1%) episodes. Excluding 2 C albicans isolates, 23 of 25 fluconazole-resistant isolates were NCAC species (14 C krusei, 6 C glabrata, 2 C parapsilosis and 1 C tropicalis). Fifty-six (42.1%) of 133 patients developed breakthrough candidaemia. Systemic antifungal prophylaxis consisted of azoles, especially fluconazole and posaconazole, in 50 (89.3%) of 56 patients in whom a breakthrough candidaemia occurred. Interestingly, all these patients tended to develop a C krusei infection (10/56, P =.02) or a fluconazole-resistant isolate’s infection (14/50, P =.04) compared to patients (4/77 and 10/77, respectively) who did not have a breakthrough candidaemia. Conclusions: Optimisation of prophylactic strategies is necessary to limit the occurrence of breakthrough candidaemia and, importantly, the emergence of fluconazole-resistant NCAC isolates’ infections in haematological malignancy patients.

Published
2020

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