Decreased Frequency and Improved Outcomes in Invasive Aspergillosis Caused by <i>Aspergillus terreus</i> After the Introduction of Anti-Mold Azole Agents: A 30-Year Study at a Tertiary Cancer Center
Invasive aspergillosis (IA) is a significant cause of morbidity and mortality in patients with hematological malignancy (HM) and hematopoietic stem cell transplant (HSCT) recipients. <i>Aspergillus terreus</i> is associated with worse outcomes than non-<i>terreus Aspergillus</i&...
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2025-02-01
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| author | Ray Y. Hachem Hiba Dagher Anne-Marie Chaftari Ying Jiang Andrea Haddad Saliba Wehbe Jishna Shrestha Robin Sherchan Peter Lamie Jennifer Makhoul Patrick Chaftari Issam I. Raad |
| author_facet | Ray Y. Hachem Hiba Dagher Anne-Marie Chaftari Ying Jiang Andrea Haddad Saliba Wehbe Jishna Shrestha Robin Sherchan Peter Lamie Jennifer Makhoul Patrick Chaftari Issam I. Raad |
| author_sort | Ray Y. Hachem |
| collection | DOAJ |
| description | Invasive aspergillosis (IA) is a significant cause of morbidity and mortality in patients with hematological malignancy (HM) and hematopoietic stem cell transplant (HSCT) recipients. <i>Aspergillus terreus</i> is associated with worse outcomes than non-<i>terreus Aspergillus</i> species. Since the introduction of anti-mold azoles in 2002, there have been limited data on the etiology of IA. We retrospectively compared characteristics, antifungal treatments, and outcomes between patients with HM or HSCT infected with <i>A. terreus</i> and those with non-<i>terreus Aspergillus</i> between July 1993 and July 2023. We also examined trends over time in rates of <i>A. terreus</i> and outcomes of this infection. A total of 699 patients with culture-documented IA were analyzed, 537 with non-<i>terreus</i> species and 162 with <i>A. terreus</i>. Types of underlying malignancy, neutropenia, graft-versus-host disease, and anti-mold prophylaxis were similar between the groups. ICU stays and mechanical ventilation were more common among patients with <i>A. terreus</i> (<i>p</i> = 0.002 and 0.003, respectively). The rate of <i>A. terreus</i> decreased significantly from 35.9% during 1993–2003 to 11.2% during 2004–2013 and 16.7% during 2014–2023 (<i>p</i> < 0.0001 each). IA caused by <i>A. terreus</i> showed significant improvements in response to therapy and in overall and IA-associated mortality in the last two decades compared to the first (<i>p</i> < 0.0001). In conclusion, the increased use of anti-mold azoles after 2003 improved outcomes for HM patients with IA caused by <i>A. terreus</i>. |
| format | Article |
| id | doaj-art-8cd78ec1d16b4fab8e256d948b0647ac |
| institution | DOAJ |
| issn | 2309-608X |
| language | English |
| publishDate | 2025-02-01 |
| publisher | MDPI AG |
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| series | Journal of Fungi |
| spelling | doaj-art-8cd78ec1d16b4fab8e256d948b0647ac2025-08-20T03:12:00ZengMDPI AGJournal of Fungi2309-608X2025-02-0111211910.3390/jof11020119Decreased Frequency and Improved Outcomes in Invasive Aspergillosis Caused by <i>Aspergillus terreus</i> After the Introduction of Anti-Mold Azole Agents: A 30-Year Study at a Tertiary Cancer CenterRay Y. Hachem0Hiba Dagher1Anne-Marie Chaftari2Ying Jiang3Andrea Haddad4Saliba Wehbe5Jishna Shrestha6Robin Sherchan7Peter Lamie8Jennifer Makhoul9Patrick Chaftari10Issam I. Raad11Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USAInvasive aspergillosis (IA) is a significant cause of morbidity and mortality in patients with hematological malignancy (HM) and hematopoietic stem cell transplant (HSCT) recipients. <i>Aspergillus terreus</i> is associated with worse outcomes than non-<i>terreus Aspergillus</i> species. Since the introduction of anti-mold azoles in 2002, there have been limited data on the etiology of IA. We retrospectively compared characteristics, antifungal treatments, and outcomes between patients with HM or HSCT infected with <i>A. terreus</i> and those with non-<i>terreus Aspergillus</i> between July 1993 and July 2023. We also examined trends over time in rates of <i>A. terreus</i> and outcomes of this infection. A total of 699 patients with culture-documented IA were analyzed, 537 with non-<i>terreus</i> species and 162 with <i>A. terreus</i>. Types of underlying malignancy, neutropenia, graft-versus-host disease, and anti-mold prophylaxis were similar between the groups. ICU stays and mechanical ventilation were more common among patients with <i>A. terreus</i> (<i>p</i> = 0.002 and 0.003, respectively). The rate of <i>A. terreus</i> decreased significantly from 35.9% during 1993–2003 to 11.2% during 2004–2013 and 16.7% during 2014–2023 (<i>p</i> < 0.0001 each). IA caused by <i>A. terreus</i> showed significant improvements in response to therapy and in overall and IA-associated mortality in the last two decades compared to the first (<i>p</i> < 0.0001). In conclusion, the increased use of anti-mold azoles after 2003 improved outcomes for HM patients with IA caused by <i>A. terreus</i>.https://www.mdpi.com/2309-608X/11/2/119<i>Aspergillus terreus</i>antifungal |
| spellingShingle | Ray Y. Hachem Hiba Dagher Anne-Marie Chaftari Ying Jiang Andrea Haddad Saliba Wehbe Jishna Shrestha Robin Sherchan Peter Lamie Jennifer Makhoul Patrick Chaftari Issam I. Raad Decreased Frequency and Improved Outcomes in Invasive Aspergillosis Caused by <i>Aspergillus terreus</i> After the Introduction of Anti-Mold Azole Agents: A 30-Year Study at a Tertiary Cancer Center Journal of Fungi <i>Aspergillus terreus</i> antifungal |
| title | Decreased Frequency and Improved Outcomes in Invasive Aspergillosis Caused by <i>Aspergillus terreus</i> After the Introduction of Anti-Mold Azole Agents: A 30-Year Study at a Tertiary Cancer Center |
| title_full | Decreased Frequency and Improved Outcomes in Invasive Aspergillosis Caused by <i>Aspergillus terreus</i> After the Introduction of Anti-Mold Azole Agents: A 30-Year Study at a Tertiary Cancer Center |
| title_fullStr | Decreased Frequency and Improved Outcomes in Invasive Aspergillosis Caused by <i>Aspergillus terreus</i> After the Introduction of Anti-Mold Azole Agents: A 30-Year Study at a Tertiary Cancer Center |
| title_full_unstemmed | Decreased Frequency and Improved Outcomes in Invasive Aspergillosis Caused by <i>Aspergillus terreus</i> After the Introduction of Anti-Mold Azole Agents: A 30-Year Study at a Tertiary Cancer Center |
| title_short | Decreased Frequency and Improved Outcomes in Invasive Aspergillosis Caused by <i>Aspergillus terreus</i> After the Introduction of Anti-Mold Azole Agents: A 30-Year Study at a Tertiary Cancer Center |
| title_sort | decreased frequency and improved outcomes in invasive aspergillosis caused by i aspergillus terreus i after the introduction of anti mold azole agents a 30 year study at a tertiary cancer center |
| topic | <i>Aspergillus terreus</i> antifungal |
| url | https://www.mdpi.com/2309-608X/11/2/119 |
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