Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database.

BACKGROUND The incidence and epidemiology of invasive fungal infections (IFIs), a leading cause of death among hematopoeitic stem cell transplant (HSCT) recipients, are derived mainly from single-institution retrospective studies. METHODS The Transplant Associated Infections Surveillance Network, a network of 23 US transplant centers, prospectively enrolled HSCT recipients with proven and probable IFIs occurring between March 2001 and March 2006. We collected denominator data on all HSCTs preformed at each site and clinical, diagnostic, and outcome information for each IFI case. To estimate trends in IFI, we calculated the 12-month cumulative incidence among 9 sequential subcohorts. RESULTS We identified 983 IFIs among 875 HSCT recipients. The median age of the patients was 49 years; 60% were male. Invasive aspergillosis (43%), invasive candidiasis (28%), and zygomycosis (8%) were the most common IFIs. Fifty-nine percent and 61% of IFIs were recognized within 60 days of neutropenia and graft-versus-host disease, respectively. Median onset of candidiasis and aspergillosis after HSCT was 61 days and 99 days, respectively. Within a cohort of 16,200 HSCT recipients who received their first transplants between March 2001 and September 2005 and were followed up through March 2006, we identified 718 IFIs in 639 persons. Twelve-month cumulative incidences, based on the first IFI, were 7.7 cases per 100 transplants for matched unrelated allogeneic, 8.1 cases per 100 transplants for mismatched-related allogeneic, 5.8 cases per 100 transplants for matched-related allogeneic, and 1.2 cases per 100 transplants for autologous HSCT. CONCLUSIONS In this national prospective surveillance study of IFIs in HSCT recipients, the cumulative incidence was highest for aspergillosis, followed by candidiasis. Understanding the epidemiologic trends and burden of IFIs may lead to improved management strategies and study design.

[1]  L. Pagano,et al.  Fungal infections in recipients of hematopoietic stem cell transplants: results of the SEIFEM B-2004 study--Sorveglianza Epidemiologica Infezioni Fungine Nelle Emopatie Maligne. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[2]  M. Labopin,et al.  Risk factors for fatal infectious complications developing late after allogeneic stem cell transplantation , 2007, Bone Marrow Transplantation.

[3]  C. Solano,et al.  Invasive fungal infections after allogeneic peripheral blood stem cell transplantation: incidence and risk factors in 395 patients , 2002, British journal of haematology.

[4]  M. Maris,et al.  Risks and outcomes of invasive fungal infections in recipients of allogeneic hematopoietic stem cell transplants after nonmyeloablative conditioning. , 2003, Blood.

[5]  T. C. White,et al.  Candidemia in allogeneic blood and marrow transplant recipients: evolution of risk factors after the adoption of prophylactic fluconazole. , 2000, The Journal of infectious diseases.

[6]  M. Boeckh,et al.  Invasive aspergillosis following hematopoietic cell transplantation: outcomes and prognostic factors associated with mortality. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[7]  Nina Singh,et al.  Impact of current transplantation practices on the changing epidemiology of infections in transplant recipients. , 2003, The Lancet. Infectious diseases.

[8]  D. Denning,et al.  Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[9]  M. Maris,et al.  Incidence and outcome of bacterial and fungal infections following nonmyeloablative compared with myeloablative allogeneic hematopoietic stem cell transplantation: a matched control study. , 2002, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[10]  G. Lyon,et al.  Comparison of the Use of Administrative Data and an Active System for Surveillance of Invasive Aspergillosis , 2008, Infection Control & Hospital Epidemiology.

[11]  J. Sinko,et al.  Invasive fungal disease in allogeneic hematopoietic stem cell transplant recipients: an autopsy‐driven survey , 2008, Transplant infectious disease : an official journal of the Transplantation Society.

[12]  R. Porcher,et al.  Risk factors for late infections after allogeneic hematopoietic stem cell transplantation from a matched related donor. , 2006, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[13]  D. Warnock.  Trends in the epidemiology of invasive fungal infections. , 2007, Nihon Ishinkin Gakkai zasshi = Japanese journal of medical mycology.

[14]  Lawrence Corey,et al.  Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[15]  C. Cordonnier,et al.  Prognostic factors for death due to invasive aspergillosis after hematopoietic stem cell transplantation: a 1-year retrospective study of consecutive patients at French transplantation centers. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[16]  W. Leisenring,et al.  The Effect of Prophylactic Fluconazole on the Clinical Spectrum of Fungal Diseases in Bone Marrow Transplant Recipients with Special Attention to Hepatic Candidiasis: An Autopsy Study of 355 Patients , 1998, Medicine.

[17]  A. Shaukat,et al.  Review of Epidemiology, Diagnosis, and Treatment of Invasive Mould Infections in Allogeneic Hematopoietic Stem Cell Transplant Recipients , 2006, Mycopathologia.

[18]  K. Wannemuehler,et al.  Incidence of invasive aspergillosis following hematopoietic stem cell and solid organ transplantation: interim results of a prospective multicenter surveillance program. , 2005, Medical mycology.

[19]  Matt Post,et al.  Invasive fungal infections in allogeneic and autologous stem cell transplant recipients: a single‐center study of 166 transplanted patients , 2007, Transplant infectious disease : an official journal of the Transplantation Society.

[20]  J. Baddley,et al.  Invasive mold infections in allogeneic bone marrow transplant recipients. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[21]  D. Kontoyiannis,et al.  Invasive fungal infections in patients with hematologic malignancies in a tertiary care cancer center: an autopsy study over a 15-year period (1989-2003). , 2006, Haematologica.

[22]  E D Thomas,et al.  1994 Consensus Conference on Acute GVHD Grading. , 1995, Bone marrow transplantation.

[23]  W. Leisenring,et al.  Epidemiology of Aspergillus infections in a large cohort of patients undergoing bone marrow transplantation. , 1997, The Journal of infectious diseases.