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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- ECCMID 30th (2020)