Characterization and outcome of invasive infections due to Paecilomyces variotii: analysis of patients from the FungiScope® registry and literature reports
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Characterization and outcome of invasive infections due to Paecilomyces variotii: analysis of patients from the FungiScope® registry and literature reports. / Sprute, Rosanne; Salmanton-García, Jon; Sal, Ertan; Malaj, Xhorxha; Falces-Romero, Iker; Hatvani, Lóránt; Heinemann, Melina; Klimko, Nikolai; López-Soria, Leyre; Meletiadis, Joseph; Shruti, Malik; Steinmann, Joerg; Seidel, Danila; Cornely, Oliver A; Stemler, Jannik.
In: J ANTIMICROB CHEMOTH, Vol. 76, No. 3, 11.02.2021, p. 765-774.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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T1 - Characterization and outcome of invasive infections due to Paecilomyces variotii: analysis of patients from the FungiScope® registry and literature reports
AU - Sprute, Rosanne
AU - Salmanton-García, Jon
AU - Sal, Ertan
AU - Malaj, Xhorxha
AU - Falces-Romero, Iker
AU - Hatvani, Lóránt
AU - Heinemann, Melina
AU - Klimko, Nikolai
AU - López-Soria, Leyre
AU - Meletiadis, Joseph
AU - Shruti, Malik
AU - Steinmann, Joerg
AU - Seidel, Danila
AU - Cornely, Oliver A
AU - Stemler, Jannik
N1 - © The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.
PY - 2021/2/11
Y1 - 2021/2/11
N2 - OBJECTIVES: To provide a basis for clinical management decisions in Paecilomyces variotii infection.METHODS: Unpublished cases of invasive P. variotii infection from the FungiScope® registry and all cases reported in the literature were analysed.RESULTS: We identified 59 cases with P. variotii infection. Main baseline factors were presence of indwelling devices in 29 cases (49.2%), particularly peritoneal catheters (33.9%) and prosthetic heart valves (10.2%), haematological or oncological diseases in 19 (32.2%), major surgery in 11 (18.6%), and diabetes mellitus in 10 cases (16.9%). The most prevalent infection sites were peritoneum (n = 20, 33.3%) and lungs (n = 16, 27.1%). Pain and fever were frequent (n = 35, 59.3% and n = 33, 55.9%, respectively). Diagnosis was established by culture in 58 cases (98.3%). P. variotii caused breakthrough infection in 8 patients. Systemic antifungals were given in 52 patients (88.1%). Amphotericin B was administered in 39, itraconazole in 15, and posaconazole in 8 patients. Clinical isolates were frequently resistant to voriconazole, whereas the above-mentioned antifungals showed good in vitro activity. Infections of the blood and CNS caused high mortality. Overall mortality was 28.8% and death was attributed to P. variotii in 10 cases.CONCLUSIONS: P. variotii causes life-threatening infections, especially in immunocompromised and critically ill patients with indwelling devices. Patients undergoing peritoneal dialysis are at particular risk. Multidisciplinary management is paramount, including molecular techniques for diagnosis and treatment with efficacious systemic antifungals. Amphotericin B, itraconazole and posaconazole are regarded as treatments of choice. Combination with flucytosine may be considered. Surgical debridement and removal of indwelling devices facilitate favourable outcome.
AB - OBJECTIVES: To provide a basis for clinical management decisions in Paecilomyces variotii infection.METHODS: Unpublished cases of invasive P. variotii infection from the FungiScope® registry and all cases reported in the literature were analysed.RESULTS: We identified 59 cases with P. variotii infection. Main baseline factors were presence of indwelling devices in 29 cases (49.2%), particularly peritoneal catheters (33.9%) and prosthetic heart valves (10.2%), haematological or oncological diseases in 19 (32.2%), major surgery in 11 (18.6%), and diabetes mellitus in 10 cases (16.9%). The most prevalent infection sites were peritoneum (n = 20, 33.3%) and lungs (n = 16, 27.1%). Pain and fever were frequent (n = 35, 59.3% and n = 33, 55.9%, respectively). Diagnosis was established by culture in 58 cases (98.3%). P. variotii caused breakthrough infection in 8 patients. Systemic antifungals were given in 52 patients (88.1%). Amphotericin B was administered in 39, itraconazole in 15, and posaconazole in 8 patients. Clinical isolates were frequently resistant to voriconazole, whereas the above-mentioned antifungals showed good in vitro activity. Infections of the blood and CNS caused high mortality. Overall mortality was 28.8% and death was attributed to P. variotii in 10 cases.CONCLUSIONS: P. variotii causes life-threatening infections, especially in immunocompromised and critically ill patients with indwelling devices. Patients undergoing peritoneal dialysis are at particular risk. Multidisciplinary management is paramount, including molecular techniques for diagnosis and treatment with efficacious systemic antifungals. Amphotericin B, itraconazole and posaconazole are regarded as treatments of choice. Combination with flucytosine may be considered. Surgical debridement and removal of indwelling devices facilitate favourable outcome.
U2 - 10.1093/jac/dkaa481
DO - 10.1093/jac/dkaa481
M3 - SCORING: Journal article
C2 - 33254240
VL - 76
SP - 765
EP - 774
JO - J ANTIMICROB CHEMOTH
JF - J ANTIMICROB CHEMOTH
SN - 0305-7453
IS - 3
ER -