Breakthrough Invasive Mold Infections in Hematologic Cases: Relevance of the Host's Factors

Area of Science:

• Hematology
• Infectious Diseases
• Mycology

Background:

• Breakthrough invasive mold infections (bIMIs) pose a significant threat to hematologic patients.
• Previous research often encompassed a broad range of fungal pathogens and antifungal treatments.

Purpose of the Study:

• To analyze the characteristics, risk factors, and outcomes of breakthrough invasive mold infections (bIMIs) in hematologic patients.
• To evaluate the incidence and attributable mortality of bIMIs in a specific patient cohort.

Main Methods:

• Retrospective study of hematologic patients diagnosed with bIMI between January 2017 and June 2022.
• Inclusion criteria: diagnosis of bIMI while on mold-active antifungal therapy.
• Data collected on patient demographics, infection details, treatment, and outcomes.

Main Results:

• 37 patients diagnosed with bIMI; Aspergillus was the most common pathogen.
• Incidence rates varied across antifungal agents, with no significant differences.
• Clinical response rate was 64.9%, and 30-day attributable mortality was 23.3%.
• Severe neutropenia and high-intensity chemotherapy were identified as risk factors.

Conclusions:

• Aspergillus is the predominant pathogen in hematologic bIMI cases.
• 30-day attributable mortality is lower than previously reported.
• Poorer performance status, higher comorbidity burden, and older age are associated with increased mortality.