171. Epidemiology and Clinical Features of Invasive Fungal Disease in a U.S. Healthcare Network
Session: Poster Abstract Session: Clinical Mycology
Thursday, October 5, 2017
Room: Poster Hall CD

Background:  A better understanding of the epidemiology and clinical features of invasive fungal disease (IFD) is integral to improving outcomes. Here we aimed to describe the incidence, clinical features and outcomes of IFD in a large U.S. healthcare network.

Methods: We developed a novel method of IFD cohort discovery to query all available records in the Intermountain Healthcare electronic data warehouse from 2006-2015 for clinical data associated with IFD (Fig.1).  Resulting data were overlaid in 124 different combinations to identify high-probability IFD cases.  The cohort was manually reviewed and exclusions applied. EORTC/MSG definitions were adapted to categorize IFD in a broad patient population.  Linear regression was used to model variation in incidence over time.

Results:  3,391 IFD episodes occurred in 3,171 patients.  Mean incidence was 27.4 cases/100,000 patients per year (Fig 2).  Estimated mean annual increase was 0.24 cases/100,000 patients (r2=0.09, p=0.21).  Candidiasis was most common (56%).  Dimorphic fungi, primarily Coccidioides, comprised 24%, followed by aspergillosis (9%).  Mean age was 50 years; pediatric cases accounted for 13%.  19.2% of patients had an active malignancy or primary immunodeficiency, 6.9% were transplant recipients and 27.5% were on immunosuppression.  Lymphopenia preceded IFD in 24.4% of patients.  Hospital admission occurred in 75%; median length of stay was 12 days.  All-cause mortality was 17% at 42 days and 28.6% at 1 year. 42-day mortality was highest in aspergillosis (27.5%), 20.5% for Candida, and lowest for dimorphic fungi (7.5%).

Conclusion:  In this population, IFD was not uncommon, affected a broad spectrum of patients and had high observed mortality.

 

Table 1.

N

%

IFD Episodes

3391

100

Proven

2259

66.6

Probable

868

25.6

Possible

264

7.8

Age (mean, SD)

50 (23.8)

Male

1744

51.4

Charlson Score (median, IQI)

3 (1, 6)

Any Malignancy

461

13.6

Leukemia/Lymphoma

211

6.2

Allogeneic BMT

106

3.1

Autologous BMT

16

0.5

Solid Organ Transplant

79

2.3

Other (HIV, etc)

551

16.2

IS Medication

932

27.5

Lymphopenia

828

24.4

Neutropenia

258

7.6

Hospitalization

2529

74.6

Length of Stay, days (median, IQI)

12 (5, 26)

42-day Mortality

575

17.0

1-year Mortality

971

28.6

BMT-Bone Marrow Transplant; IS-immunosuppressive;

 

 

 

 

Figure 1. Cohort Discovery Flowchart


Figure 2. Trends in Invasive Fungal Disease Incidence

 

Brandon Webb, MD1, Jeffrey Ferraro, PhD2, Susan Rea, PhD, BSN2, Jennifer Kammerer, PharmD, MS3, Stephanie Kaufusi, BS4, Bruce Goodman, BS4, Greta Martin, MHE5 and James Spalding, PharmD, MS, MBA6, (1)Intermountain Medical Center and LDS Hospital, Murray, UT, (2)Homer Warner Center for Informatics Research, Intermountain Healthcare, Murray, UT, (3)Scientific and Medical Affairs, Astellas Pharma Global Development, Inc., Northbrook, IL, (4)Innovations and Business Development, Intermountain Healthcare, Murray, UT, (5)Innovations and Business Development, Intermountain Healthcare, Salt Lake City, UT, (6)Astellas Pharma Global Development, Inc., Northbrook, IL

Disclosures:

B. Webb, Astellas Pharma Global Development, Inc.: Grant Investigator , Research grant

J. Ferraro, Astellas Pharma Global Development, Inc.: Grant Investigator , Research support

S. Rea, Astellas Pharma Global Development, Inc.: Grant Investigator , Research support

J. Kammerer, Astellas Pharma Global Development, Inc.: Employee , Salary

S. Kaufusi, Astellas Pharma Global Development, Inc.: Grant Investigator , Research support

B. Goodman, Astellas Pharma Global Development, Inc.: Grant Investigator , Research support

G. Martin, Astellas Pharma Global Development, Inc.: Grant Investigator , Research support

J. Spalding, Astellas Pharma Global Development, Inc.: Employee , Salary

See more of: Clinical Mycology
See more of: Poster Abstract Session

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.