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Original article

Vol. 154 No. 3 (2024)

Investigations of an increased incidence of non-Aspergillus invasive mould infections in an onco-haematology unit

  • Elisavet Stavropoulou
  • Anne Huguenin
  • Giorgia Caruana
  • Onya Opota
  • Nancy Perrottet
  • Dominique S. Blanc
  • Bruno Grandbastien
  • Laurence Senn
  • Pierre-Yves Bochud
  • Frederic Lamoth
DOI
https://doi.org/10.57187/s.3730
Cite this as:
Swiss Med Wkly. 2024;154:3730
Published
26.03.2024

Summary

AIMS OF THE STUDY: Invasive mould infections are life-threatening complications in patients with haematologic cancer and chemotherapy-induced neutropenia. While invasive aspergillosis represents the main cause of invasive mould infections, non-Aspergillus mould infections, such as mucormycosis, are increasingly reported. Consequently, their local epidemiology should be closely monitored. The aim of this study was to investigate the causes of an increased incidence of non-Aspergillus mould infections in the onco-haematology unit of a Swiss tertiary care hospital.

METHODS: All cases of proven and probable invasive mould infections were retrospectively identified via a local registry for the period 2007–2021 and their incidence was calculated per 10,000 patient-days per year. The relative proportion of invasive aspergillosis and non-Aspergillus mould infections was assessed. Factors that may affect invasive mould infections’ incidence, such as antifungal drug consumption, environmental contamination and changes in diagnostic approaches, were investigated.

RESULTS: A significant increase of the incidence of non-Aspergillus mould infections (mainly mucormycosis) was observed from 2017 onwards (Mann and Kendall test p = 0.0053), peaking in 2020 (8.62 episodes per 10,000 patient-days). The incidence of invasive aspergillosis remained stable across the period of observation. The proportion of non-Aspergillus mould infections increased significantly from 2017 (33% vs 16.8% for the periods 2017–2021 and 2007–2016, respectively, p = 0.02). Building projects on the hospital site were identified as possible contributors of this increase in non-Aspergillus mould infections. However, novel diagnostic procedures may have improved their detection.

CONCLUSIONS: We report a significant increase in non-Aspergillus mould infections, and mainly in mucormycosis infections, since 2017. There seems to be a multifactorial origin to this increase. Epidemiological trends of invasive mould infections should be carefully monitored in onco-haematology units in order to implement potential corrective measures.

References

  1. Pagano L, Caira M, Candoni A, Offidani M, Fianchi L, Martino B, et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica. 2006 Aug;91(8):1068–75.
  2. Rodríguez-Veiga R, Montesinos P, Boluda B, Lorenzo I, Martínez-Cuadrón D, Salavert M, et al. Incidence and outcome of invasive fungal disease after front-line intensive chemotherapy in patients with acute myeloid leukemia: impact of antifungal prophylaxis. Ann Hematol. 2019 Sep;98(9):2081–8. 10.1007/s00277-019-03744-5 DOI: https://doi.org/10.1007/s00277-019-03744-5
  3. Lamoth F, Kontoyiannis DP. Therapeutic Challenges of Non-Aspergillus Invasive Mold Infections in Immunosuppressed Patients. Antimicrob Agents Chemother. 2019 Oct;63(11):e01244-19. 10.1128/AAC.01244-19 DOI: https://doi.org/10.1128/AAC.01244-19
  4. Skiada A, Pagano L, Groll A, Zimmerli S, Dupont B, Lagrou K, et al.; European Confederation of Medical Mycology Working Group on Zygomycosis. Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007. Clin Microbiol Infect. 2011 Dec;17(12):1859–67. 10.1111/j.1469-0691.2010.03456.x DOI: https://doi.org/10.1111/j.1469-0691.2010.03456.x
  5. Bitar D, Van Cauteren D, Lanternier F, Dannaoui E, Che D, Dromer F, et al. Increasing incidence of zygomycosis (mucormycosis), France, 1997-2006. Emerg Infect Dis. 2009 Sep;15(9):1395–401. 10.3201/eid1509.090334 DOI: https://doi.org/10.3201/eid1509.090334
  6. Lamoth F, Chung SJ, Damonti L, Alexander BD. Changing Epidemiology of Invasive Mold Infections in Patients Receiving Azole Prophylaxis. Clin Infect Dis. 2017 Jun;64(11):1619–21. 10.1093/cid/cix130 DOI: https://doi.org/10.1093/cid/cix130
  7. Parra Fariñas R, Alonso-Sardón M, Velasco-Tirado V, Pérez IG, Carbonell C, Álvarez Artero E, et al. Increasing Incidence of mucormycosis in Spanish inpatients from 1997 to 2018. Mycoses. 2022 Mar;65(3):344–53. 10.1111/myc.13418 DOI: https://doi.org/10.1111/myc.13418
  8. Saegeman V, Maertens J, Meersseman W, Spriet I, Verbeken E, Lagrou K. Increasing incidence of mucormycosis in University Hospital, Belgium. Emerg Infect Dis. 2010 Sep;16(9):1456–8. 10.3201/eid1609.100276 DOI: https://doi.org/10.3201/eid1609.100276
  9. Kanamori H, Rutala WA, Sickbert-Bennett EE, Weber DJ. Review of fungal outbreaks and infection prevention in healthcare settings during construction and renovation. Clin Infect Dis. 2015 Aug;61(3):433–44. 10.1093/cid/civ297 DOI: https://doi.org/10.1093/cid/civ297
  10. Greub G, Sahli R, Brouillet R, Jaton K. Ten years of R&D and full automation in molecular diagnosis. Future Microbiol. 2016;11(3):403–25. 10.2217/fmb.15.152 DOI: https://doi.org/10.2217/fmb.15.152
  11. Millon L, Larosa F, Lepiller Q, Legrand F, Rocchi S, Daguindau E, et al. Quantitative polymerase chain reaction detection of circulating DNA in serum for early diagnosis of mucormycosis in immunocompromised patients. Clin Infect Dis. 2013 May;56(10):e95–101. 10.1093/cid/cit094 DOI: https://doi.org/10.1093/cid/cit094
  12. Donnelly JP, Chen SC, Kauffman CA, Steinbach WJ, Baddley JW, Verweij PE, et al.; Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis. 2020 Sep;71(6):1367–76. 10.1093/cid/ciz1008
  13. Segal BH, Herbrecht R, Stevens DA, Ostrosky-Zeichner L, Sobel J, Viscoli C, et al. Defining responses to therapy and study outcomes in clinical trials of invasive fungal diseases: Mycoses Study Group and European Organization for Research and Treatment of Cancer consensus criteria. Clin Infect Dis. 2008 Sep;47(5):674–83. 10.1086/590566 DOI: https://doi.org/10.1086/590566
  14. Vonberg RP, Gastmeier P. Nosocomial aspergillosis in outbreak settings. J Hosp Infect. 2006 Jul;63(3):246–54. 10.1016/j.jhin.2006.02.014 DOI: https://doi.org/10.1016/j.jhin.2006.02.014
  15. Guemas E, Cassaing S, Malavaud S, Fillaux J, Chauvin P, Lelièvre L, et al. A Clustered Case Series of Mucorales Detection in Respiratory Samples from COVID-19 Patients in Intensive Care, France, August to September 2021. J Fungi (Basel). 2022 Mar;8(3):258. 10.3390/jof8030258 DOI: https://doi.org/10.3390/jof8030258
  16. Begert M, Frei C. Long-term area-mean temperature series for Switzerland-Combining homogenized station data and high resolution grid data. Int J Climatol. 2018;38(6):2792–807. 10.1002/joc.5460 DOI: https://doi.org/10.1002/joc.5460
  17. John TM, Jacob CN, Kontoyiannis DP. When Uncontrolled Diabetes Mellitus and Severe COVID-19 Converge: The Perfect Storm for Mucormycosis. J Fungi (Basel). 2021 Apr;7(4):298. 10.3390/jof7040298 DOI: https://doi.org/10.3390/jof7040298
  18. Lamoth F, Damonti L, Alexander BD. Role of Antifungal Susceptibility Testing in Non-Aspergillus Invasive Mold Infections. J Clin Microbiol. 2016 Jun;54(6):1638–40. 10.1128/JCM.00318-16 DOI: https://doi.org/10.1128/JCM.00318-16
  19. Lanternier F, Dannaoui E, Morizot G, Elie C, Garcia-Hermoso D, Huerre M, et al. A global analysis of mucormycosis in France: the RetroZygo Study (2005-2007). Clin Infect Dis. 2012 Feb;54 Suppl 1(S35-43. DOI: https://doi.org/10.1093/cid/cir880
  20. Marty FM, Ostrosky-Zeichner L, Cornely OA, Mullane KM, Perfect JR, Thompson GR 3rd, et al.; VITAL and FungiScope Mucormycosis Investigators. Isavuconazole treatment for mucormycosis: a single-arm open-label trial and case-control analysis. Lancet Infect Dis. 2016 Jul;16(7):828–37. 10.1016/S1473-3099(16)00071-2
  21. Cornely OA, Alastruey-Izquierdo A, Arenz D, Chen SC, Dannaoui E, Hochhegger B, et al.; Mucormycosis ECMM MSG Global Guideline Writing Group. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019 Dec;19(12):e405–21. 10.1016/S1473-3099(19)30312-3
  22. Koehler P, Mellinghoff SC, Lagrou K, Alanio A, Arenz D, Hoenigl M, et al. Development and validation of the European QUALity (EQUAL) score for mucormycosis management in haematology. J Antimicrob Chemother. 2019 Jun;74(6):1704–12. 10.1093/jac/dkz051 DOI: https://doi.org/10.1093/jac/dkz051

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