403. Invasive Fusariosis (FUS) in Patients (pts) with Hematologic Malignancy (HM) at MD Anderson Cancer Center: The Last Decade
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Fusarium species cause severe, frequently disseminated infections in HM pts. There are no recent studies regarding the natural history of FUS in the era of the expanded antifungal armamentarium.
Methods: We identified all HM pts with positive cultures for Fusarium species at the MDACC (1998-2009). The diagnosis of documented (proven or probable) FUS was made according to modified EORTC/MSG criteria. Factors associated with 12-week crude mortality were evaluated by Chi-square and multivariate logistic regression. Nosocomial FUS was defined according to CDC criteria.
Results: 44 cases of FUS (75% proven) were identified. Nosocomial incidence decreased from 4.09 to 1.19 per 100,000 pt days (P=0.29). Most (70%) pts had uncontrolled HM and 21 (47%) received HSCT (87% allogeneic).
The majority (82%) were neutropenic (75% <100/mm³); 70 % recovered. Pts presented with different overlapping clinical syndromes: Sinus 27%, pulmonary 75%, skin 68%, fungemia 38% and disseminated infection 70.5%. Bacterial (54%), fungal (36%) and viral (27%) co-infections were common. Most pts (84%) received combination therapy (typically a lipid AMB and a triazole) with a mean duration of 28 days.G-CSF and WBC transfusions were administered to 77% and 43% of pts. Mortality at 12 weeks was 66%; 50% of deaths were attributable to Fusarium and 23% to underlying disease. Many pts (54%) failed treatment at 12 weeks. Albumin < 3.5 mg/dL, fungemia at diagnosis, and antifungal drug toxicity were associated with increased mortality at 12 weeks, while neutrophil recovery and FUS limited to skin and soft tissue were associated with improved survival (P<0.05). However, fungemia (OR 15.98; 1.1-231; P= 0.042) was the only independent risk factor for 12 week mortality; only 1/17 (6%) of pts still alive at 12 weeks.
Conclusions: FUS remains an uncommon, yet severe opportunistic mycosis in pts with HM. The efficacy of modern antifungals, even in combinations, is poor in the absence of neutrophil recovery. Fungemia is a marker of aggressive course and poor prognosis.
Marcela Campo, MD, UT MD Anderson Cancer Center, Houston, TX, Dimitrios Kontoyiannis, MD, ScD, FIDSA, The University of Texas M.D. Anderson Cancer Center, Houston, TX, Russell Lewis, PharmD, Clinical Sciences and Administration, University of Houston College of Pharmacy, Houston, TX and  M. Campo, None..
R. E. Lewis, None. 
D. P. Kontoyiannis,
Merck Role(s): Board Member, Consultant, Received: Grant Recipient, Research Grant, Research Support, Speaker Honorarium, Consulting Fee.
Pfizer Role(s): Other, Received: Speaker Honorarium.
Schering Plough Role(s): Board Member, Consultant, Received: Speaker Honorarium, Consulting Fee.
Enzon Role(s): Other, Received: Grant Recipient, Research Grant, Research Support, Speaker Honorarium.
Astellas Role(s): Other, Received: Grant Recipient, Research Grant, Speaker Honorarium, Consulting Fee.

Disclosures:

M. Campo, None

D. Kontoyiannis, None

R. Lewis, None