Methods: Proven/probable NAIMIs developed in patients with hematologic diseases were reviewed from JAN 2011 to JAN 2018 at the Catholic Blood and Marrow Transplantation Center.
Results: There were 662 patients with proven/probable IMIs, of which 40 patients (41 isolates) were diagnosed with NAIMIs. The incidence of NAIMIs showed an increasing trend since 2013 when posaconazole prophylaxis was approved in Korea [correlation coefficient (r) = 0.735, p = 0.265]. Mucormycosis (n = 24, 58.5%) was the most common, followed by Fusarium (n = 7, 17.1%), Alternaria (n = 2), Scopulariopsis (n = 2), Scedosporium (n = 2), Paecilomyces (n = 1), Coprinus (n = 1), Chaetomium (n = 1), and Schizophyllum (n = 1). Twenty-eight patients were under neutropenia upon diagnosis of NAIMI and 35.0% were allogeneic stem cell transplantation recipients. The most common sites of NAIMI were the lungs (60.0%), followed by the paranasal sinus (17.5%) and disseminated infections (12.5%). There were 35.5% breakthrough IMI cases. In addition, there were 42.5% mixed or concurrent IFIs and 77.5% had coexisting bacterial or viral infections. The overall mortality at 6- and 12-weeks was 32.5% and 42.5%, respectively. The mortality rates for mucormycosis and non-mucormycosis at 6-week were 21.7% and 47.1%, respectively. Breakthrough IFIs [adjusted hazards ratio (HR) = 4.83, p = 0.018] and surgical treatment [HR = 0.09, p = 0.003] were independently associated with 6-week mortality.
Conclusion: NAIMIs showed an increasing trend, mixed/concurrent IFIs were substantial, and coexisting bacterial or viral infections were found in more than two-thirds of patients. Breakthrough IFIs and surgical treatment have significant impact on mortality. More meticulous approaches to diagnosis and treatment strategies of NAIMIs are needed.
H. J. Lee,
S. Y. Cho, None