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Invasive Fusariosis in Nonneutropenic Patients, Spain, 2000-2015
Abstract:
Invasive fusariosis (IF) is associated with severe neutropenia in patients with concurrent hematologic conditions. We conducted a retrospective observational study to characterize the epidemiology of IF in 18 Spanish hospitals during 2000-2015. In that time, the frequency of IF in nonneutropenic patients increased from 0.08 cases per 100,000 admissions in 2000-2009 to 0.22 cases per 100,000 admissions in 2010-2015. Nonneutropenic IF patients often had nonhematologic conditions, such as chronic cardiac or lung disease, rheumatoid arthritis, history of solid organ transplantation, or localized fusariosis. The 90-day death rate among nonneutropenic patients (28.6%) and patients with resolved neutropenia (38.1%) was similar. However, the death rate among patients with persistent neutropenia (91.3%) was significantly higher. We used a multivariate Cox regression analysis to characterize risk factors for death: persistent neutropenia was the only risk factor for death, regardless of antifungal therapy.
Insights
Invasive fusariosis (IF) is increasingly seen in nonneutropenic patients. Persistent neutropenia is the primary risk factor for death in IF patients, irrespective of antifungal treatment.
Area of Science:
- Infectious Diseases
- Hematology
- Epidemiology
Background:
- Invasive fusariosis (IF) is a serious fungal infection typically linked to severe neutropenia in patients with hematologic conditions.
- Recent observations suggest a potential rise in IF cases among nonneutropenic individuals.
Purpose of the Study:
- To investigate the epidemiological trends of invasive fusariosis in Spain between 2000 and 2015.
- To characterize the clinical features and risk factors associated with mortality in IF patients, particularly focusing on neutropenic status.
Main Methods:
- A retrospective observational study was conducted across 18 Spanish hospitals.
- Data on IF cases, patient characteristics (including neutropenic status and comorbidities), and outcomes were collected from 2000 to 2015.
- Multivariate Cox regression analysis was employed to identify independent risk factors for death.
Main Results:
- The incidence of IF in nonneutropenic patients increased from 0.08 to 0.22 cases per 100,000 admissions between the periods 2000-2009 and 2010-2015.
- Nonneutropenic IF patients frequently presented with nonhematologic comorbidities like chronic cardiac/lung disease, rheumatoid arthritis, or a history of solid organ transplantation.
- The 90-day mortality rate was significantly higher in patients with persistent neutropenia (91.3%) compared to those who were nonneutropenic (28.6%) or had resolved neutropenia (38.1%).
Conclusions:
- Persistent neutropenia emerged as the sole independent risk factor for mortality in invasive fusariosis patients.
- Antifungal therapy did not alter the significant impact of persistent neutropenia on survival outcomes.
- The rising incidence of IF in nonneutropenic patients warrants further investigation into underlying risk factors and management strategies.
