Patient Characteristics and Risk Factors in Invasive Mold Infections: Comparison from a Systematic Review and
Anita H Sung1, Stephan Martin2, Bryant Phan1
1Pfizer Inc, New York, NY, USA.
Introduction:
Diagnosis and treatment of invasive mold infections (IMI) can be challenging and IMI is a significant source of morbidity and mortality. Invasive aspergillosis (IA) and invasive mucormycosis (IM) are two of the most common mold infections. A better understanding of patient comorbidities and risk factors that predispose IMI may help clinicians to refine the difficult diagnostic and treatment process.
Methods:
A systematic literature review (SLR) was conducted (January 2008-October 2019) for studies reporting comorbidities/risk factors of patients with IA or IM (Phase I), followed by an analysis on the Optum® US EHR database of prominent risk factor cohorts based on SLR findings and expert opinion (Phase II). From the four identified patient cohorts: 1) patients undergoing solid organ transplant (SOT) and patients with 2) hematologic cancers, 3) diabetes, or 4) lung disease, rates of IA, IM, or concurrent IA and IM; patient comorbidities; and Charlson Comorbidity Index (CCI) scores were reported.
Results:
The SLR included 88 studies, and 46 were used to select comorbidities/risk factors cohorts in IA and IM patients. The most important comorbidities/risk factors in IA and IM patients were diabetes, lung disease, hematological malignances, and SOT. In the Optum database (N=101,340,454 patients), IA rates were highest in lung transplant (10.81%) patients and IM rates were highest in intestine transplant (0.83%) patients, lung transplant (0.43%), and hematopoietic stem cell transplant (0.49%). CCI scores were elevated in all mold infection groups compared to the total Optum cohort.
Conclusion:
The current study describes patient comorbidity and risk factors associated with IA and IM. These data can be used to refine clinical decision-making regarding when to suspect mold infections. Future research should focus on identifying whether patients respond differently to various antifungal treatments to determine if strategic recommendations should be made for certain patient groups.
Insights
Understanding patient comorbidities and risk factors is crucial for diagnosing and treating invasive mold infections (IMI), such as invasive aspergillosis (IA) and invasive mucormycosis (IM). This study identified key risk factors to aid clinical decision-making.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Epidemiology
Background:
- Invasive mold infections (IMI), including invasive aspergillosis (IA) and invasive mucormycosis (IM), present significant diagnostic and therapeutic challenges, contributing to substantial morbidity and mortality.
- Identifying patient comorbidities and predisposing risk factors is essential for refining the diagnostic and treatment strategies for IMI.
Purpose of the Study:
- To systematically review and analyze patient comorbidities and risk factors associated with invasive aspergillosis (IA) and invasive mucormycosis (IM).
- To identify high-risk patient cohorts for IA and IM based on a large electronic health record database.
Main Methods:
- A systematic literature review (SLR) was conducted from January 2008 to October 2019 to identify comorbidities and risk factors for IA and IM.
- Phase II involved analyzing the Optum® US Electronic Health Record (EHR) database to assess IA and IM rates, comorbidities, and Charlson Comorbidity Index (CCI) scores in specific patient cohorts (solid organ transplant, hematologic cancers, diabetes, lung disease).
Main Results:
- The SLR included 88 studies, identifying diabetes, lung disease, hematological malignancies, and solid organ transplant (SOT) as key risk factors for IA and IM.
- Analysis of the Optum EHR database (over 101 million patients) revealed the highest IA rates in lung transplant recipients (10.81%) and the highest IM rates in intestine transplant recipients (0.83%).
- Elevated CCI scores were observed in all identified mold infection groups compared to the general patient population.
Conclusions:
- The study provides critical insights into patient comorbidities and risk factors associated with IA and IM, aiding in earlier clinical suspicion.
- Further research is recommended to investigate differential patient responses to antifungal treatments, potentially leading to tailored therapeutic strategies for specific patient groups.
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