Prospective study of breakthrough invasive fungal infections in haematologic patients in Spain

Estela Moreno *1, Pedro Puerta 1, Juan Carlos Soto-Debrán 2, Cecilia Martin Gandul 3, Montserrat Batlle 4, Jon Badiola 5, Ana Fernandez-Cruz 6, Marina Machado 7, Juan Carlos Ramos Ramos 8, Lucia Gomez 9, Carlota Gudiol 10, Isabel Ruiz 11, Mariana Chumbita 1,Pilar Martín-Dávila 12, Lucrecia Yañez 13, Lourdes Vázquez 14, Nicole Garcia-Pouton 1, Jesus Fortun Abete 12, Julio García Rodríguez 8,Pedro González 5, Francesc Marco Reverte 1, Isabel Sanchez-Romero 6, María Dolores Quesada 4, Jesus Guinea Ortega 7, Manuela Aguilar-Guisado 3, Alex Soriano 1, Ana Alastruey-Izquierdo 2, Carolina Garcia Vidal 1

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1 Hospital Clínic, Barcelona, Spain; 2 Instituto de Salud Carlos III, Madrid, Spain; 3 Hospital Universitario Virgen del Rocío, Sevilla, Spain; 4 Hospital Universitari Germans Trias i Pujol, Badalona, Spain; 5 Hospital Universitario Virgen de las Nieves, Granada,Spain; 6 Hospital Puerta de Hierro, Madrid, Spain; 7 Hospital Gregorio Marañón, Madrid, Spain; 8 Hospital Universitario La Paz, Madrid, Spain; 9 Hospital Universitario Mutua Terrasa, Terrasa, Spain; 10 Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat,Spain; 11 Hospital Universitario Vall d’Hebron, Barcelona, Spain; 12 Hospital Ramón y Cajal, Madrid, Spain; 13 Hospital Universitario Marqués de Valdecilla, Santander, Spain; 14 Hospital Universitario de Salamanca, Salamanca, Spain


Background: Breakthrough invasive fungal infections (BtIFI) are an emerging problem; however prospective epidemiological data are lacking. We aimed to describe the current epidemiology, treatment and outcomes of BtIFI in hematological patients in Spain.

Materials/methods: Prospective descriptive cohort study of all consecutive BtIFI diagnosed according to the revised EORTC criteria in 13 Spanish hospitals from September 2017 to July 2019 (22 months). BtIFI was defined as any IFI occurring in patients with ≥5 days of antifungals within the last week. Antifungal susceptibility was tested in the Spanish National Center for Microbiology.

Results: 84 BtIFI were diagnosed: 25 (29.8%) proven, 36 (42.9%) probable and 21 (25%) possible. Most common underlying diseases were acute myeloid leukemia (44%) and hematopoietic stem cell transplantation (19%). Table 1 details the microbiological characteristics of the proven cases. Most frequent prior antifungals were posaconazole (31%), fluconazole (27.4%) and echinocandins (22.7%); administered for primary prophylaxis (71.4%), secondary prophylaxis (10.7%) and preemptive therapy (6%). Antifungal therapy was usually changed (84.5%), commonly to liposomal Amphotericin B (42.9%). 100-day mortality was 51.2%.

Conclusions: Aspergillosis is still the most frequent cause of BtIFI but the appearance of rare fungi like Mucorales, Geotrichum or Fusarium and non-albicans Candida infections was evidenced. Most proven BtIFI were resistant to the prior antifungal administered. Mortality rate was high.

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European Congress of Clinical Microbiology and Infectious Diseases 2020
    • ECCMID 30th (2020)