101. International retrospective analysis of 73 cases of invasive fusariosis treated with voriconazole
- Author
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Pinaki Biswas, Raoul Herbrecht, Issam I Raad, Karine Sitbon, Elisabeth Chachaty, Peter F. Troke, Denis Caillot, Anne-Lise Bienvenu, Frédéric Grenouillet, Muriel Cornet, Claire Lacroix, John H. Greene, Gaelle Obenga, Olivier Lortholary, Centre d'infectiologie Necker-Pasteur [CHU Necker], Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Mycologie moléculaire, Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Centre National de Référence Mycologie et Antifongiques-Mycologie Moléculaire (CNRMA), Institut Pasteur [Paris], CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Département de biologie et pathologie médicales [Gustave Roussy], Institut Gustave Roussy (IGR), Centre National de Référence des Borrelia (CNR), Microbiologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5), Service d'Hématologie, CHU Strasbourg, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS), CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Descartes - Paris 5 (UPD5), Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Institut Pasteur [Paris] (IP), Laboratoire Chrono-environnement (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), CHU Necker - Enfants Malades [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique ( CNRS ), Centre National de Référence Mycologie et Antifongiques-Mycologie Moléculaire ( CNRMA ), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Institut Gustave Roussy ( IGR ), Centre National de Référence des Borrelia ( CNR ), Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Descartes - Paris 5 ( UPD5 ), Laboratoire Chrono-environnement - UFC (UMR 6249) ( LCE ), and Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ) -Université Bourgogne Franche-Comté [COMUE] ( UBFC )
- Subjects
Male ,Antifungal Agents ,MESH : Retrospective Studies ,medicine.medical_treatment ,MESH : Pyrimidines ,MESH : Aged ,MESH : Child, Preschool ,Gastroenterology ,0302 clinical medicine ,Fusarium ,MESH : Child ,MESH: Child ,MESH : Female ,Pharmacology (medical) ,030212 general & internal medicine ,Child ,[ SDV.MP.MYC ] Life Sciences [q-bio]/Microbiology and Parasitology/Mycology ,[SDV.MP.MYC]Life Sciences [q-bio]/Microbiology and Parasitology/Mycology ,MESH: Treatment Outcome ,MESH: Aged ,0303 health sciences ,MESH: Fusarium ,MESH: Middle Aged ,Immunosuppression ,Middle Aged ,MESH : Adult ,3. Good health ,Treatment Outcome ,Infectious Diseases ,MESH: Young Adult ,Child, Preschool ,Female ,medicine.drug ,Adult ,Fusariosis ,medicine.medical_specialty ,Adolescent ,Combination therapy ,MESH : Male ,MESH : Antifungal Agents ,MESH : Young Adult ,MESH : Treatment Outcome ,Clinical Therapeutics ,Neutropenia ,Young Adult ,03 medical and health sciences ,Pharmacotherapy ,MESH: Mycoses ,MESH : Adolescent ,Internal medicine ,MESH : Triazoles ,medicine ,Humans ,MESH : Fusarium ,MESH : Middle Aged ,Aged ,Retrospective Studies ,MESH : Mycoses ,Pharmacology ,Voriconazole ,MESH: Adolescent ,MESH: Humans ,030306 microbiology ,business.industry ,MESH : Humans ,MESH: Child, Preschool ,Retrospective cohort study ,MESH: Adult ,MESH: Retrospective Studies ,Triazoles ,medicine.disease ,MESH: Antifungal Agents ,MESH: Male ,Surgery ,Transplantation ,Pyrimidines ,Mycoses ,MESH: Triazoles ,MESH: Pyrimidines ,business ,MESH: Female - Abstract
The outcomes for 73 invasive fusariosis patients treated with voriconazole were investigated. Patients with proven ( n = 67) or probable ( n = 6) infections were identified from the voriconazole clinical database ( n = 39) and the French National Reference Center for Mycoses and Antifungals database ( n = 34). Investigator-determined success was a complete or partial response. Survival was determined from day 1 of voriconazole therapy to the last day known alive. Patients were 2 to 79 years old (median, 43 years), and 66% were male. Identified Fusarium species (62%) were F. solani , F. moniliforme , F. proliferatum , and F. oxysporum . Underlying conditions analyzed included hematopoietic stem cell transplant (HSCT; 18%), hematologic malignancy (HM; 60%), chronic immunosuppression (CI; 12%), or other condition (OC; 10%). Infection sites were brain (5%), disseminated excluding brain (67%), lungs/sinus (15%), and other (12%). Most patients (64%) were or had recently been neutropenic (3 ). Therapy duration was 1 to 480 days (median, 57 days), with a 47% success rate. Baseline neutropenia impacted success adversely ( P ≤ 0.03). Success varied by underlying condition (HSCT, 38%; HM, 45%; CI, 44%; OC, 71%) and infection site (brain, 0%; disseminated, 45%; other, 56%; lung/sinus, 64%) ( P > 0.05). Combination therapy (13 patients) was no better than treatment with voriconazole alone. Overall, 59% of the patients died (49% died of fusariosis), and 90-day survival was 42%. Site of infection influenced survival ( P = 0.02). Median survival (in days) by species was as follows: F. solani , 213; F. oxysporum , 112; Fusarium spp., 101; F. proliferatum , 84; F. moniliforme , 76. We conclude that voriconazole is a therapeutic option for invasive fusariosis.
- Published
- 2010