流行病学和与霉菌阳性血培养相关的预后因素：来自法国前瞻性监测项目（2012-2022）的10年数据。

IF 8.2 1区医学 Q1 IMMUNOLOGY Clinical Infectious Diseases Pub Date : 2025-01-09 DOI:10.1093/cid/ciae594

Thiziri Tala-Ighil, Dea Garcia-Hermoso, Frédéric Dalle, Sophie Cassaing, Juliette Guitard, Karine Boukris-Sitbon, Thomas Obadia, Olivier Lortholary, Valérie Letscher-Bru, Marie-Pierre Ledoux, Taïeb Chouaki, Anne Pauline Bellanger, Célia Rouges, Marie Elisabeth Bougnoux, Maxime Moniot, Marc Pihet, Vincent Dubée, Frédéric Gabriel, Florent Morio, Lilia Hasseine, Christine Bonnal, Maud Gits-Muselli, Estelle Perraud-Cateau, Caroline Mahinc, Muriel Nicolas, Elisabeth Chachaty, Camille Cordier, Laurence Lachaud, Laura Courtellemont, Benoït Henry, Cécile Angebault, Gilles Gargala, Adélaïde Chesnay, Marie Liesse Pacreau, Laure Kamus, Nicole Desbois-Nogard, Magalie Demar, Loïc Epelboin, Alexandre Alanio, Eric Dannaoui, Fanny Lanternier

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引用次数: 0

摘要

背景：虽然已知侵袭性镰孢菌病和结节孢子病与真菌血症有关，但霉菌相关真菌血症的总体数据有限，妨碍了早期管理。本研究旨在描述霉菌阳性血培养的流行病学。方法：从RESSIF数据库中获取2012 - 2022年霉菌阳性血培养的流行病学和临床资料。采用改进的Duthie和Denning标准排除假真菌病。采用单变量和多变量Firth逻辑回归研究与90天死亡率相关的因素。结果：80例病原菌中镰刀菌占67.5%，主要包括藤黑镰刀菌复合体（Fusarium fujikuroi spp complex， FFSC）、新宇宙孢菌复合体（Neocosmospora spp）和尖孢镰刀菌复合体（Fusarium oxysporum spp complex， FOSC）。第二常见的是增生性Lomentospora prolificans(10%)，其次是木霉、曲霉和毛霉菌（各占5%）。大多数患者有血液系统恶性肿瘤史（HM）（70%）。43%的患者接受了异基因造血干细胞移植。皮肤和肺部病变常见（各占43%）。血培养阳性的中位时间为72小时。HM和中性粒细胞减少症常见于FFSC、新宇宙孢子菌和增生性乳杆菌真菌血症患者。肺病变多见于增生性乳杆菌真菌血症。胃肠道疾病患者常被诊断为FOSC霉菌。HM(75%)，特别是急性髓母细胞白血病，常见于曲霉属真菌血症患者。所有木霉菌血症患者均暴露于皮质类固醇。第90天死亡率为53%。第90天死亡率的独立预测因素包括增生性乳杆菌（比值比[OR]， 33.3）、曲霉真菌血症（比值比，14.2）和皮质类固醇暴露（比值比，7.85）。结论：基础条件和临床表现因属而异，可以考虑指导早期治疗。

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Epidemiology and Prognostic Factors Associated With Mold-Positive Blood Cultures: 10-Year Data From a French Prospective Surveillance Program (2012-2022).

Background: While invasive fusariosis and lomentosporiosis are known to be associated with fungemia, overall data on mold-related fungemia are limited, hampering early management. This study aimed to describe the epidemiology of mold-positive blood cultures.

Methods: Epidemiological and clinical data on mold-positive blood cultures from 2012 to 2022 were obtained from the RESSIF database. Pseudofungemia was excluded using modified Duthie and Denning criteria. Univariable and multivariable Firth logistical regression was used to study factors associated with 90-day mortality.

Results: Fusarium spp accounted for 67.5% of the 80 events, involving predominantly Fusarium fujikuroi spp complex (FFSC), Neocosmospora spp, and Fusarium oxysporum spp complex (FOSC). Lomentospora prolificans was the second most frequent (10%), followed by Trichoderma spp, Aspergillus spp, and Mucorales (5% each).Most patients had a history of hematological malignancy (HM) (70%). Forty-three percent had undergone allogeneic hematopoietic stem cell transplantation. Cutaneous and pulmonary lesions were common (43% each). Median time to blood culture positivity was 72 hours.HM and neutropenia were commonly reported in patients with FFSC, Neocosmospora spp, and L. prolificans fungemia. Pulmonary lesions were frequent in cases of L. prolificans fungemia. Patients with gastrointestinal conditions were frequently diagnosed with FOSC molds. HM (75%), particularly acute myeloblastic leukemia, was frequent in patients with Aspergillus spp fungemia. All patients with Trichoderma spp fungemia were exposed to corticosteroids.Day 90 mortality was 53%. Independent predictive factors of day 90 mortality included L. prolificans (odds ratio [OR], 33.3), Aspergillus spp fungemia (OR, 14.2), and corticosteroid exposure (OR, 7.85).

Conclusions: Underlying conditions and clinical presentation vary between genera and could be considered to guide early management.

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来源期刊

Clinical Infectious Diseases 医学-传染病学

CiteScore

25.00

自引率

2.50%

发文量

900

审稿时长

3 months

期刊介绍： Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.