Invited Speaker Australian Society for Microbiology Annual Scientific Meeting 2023

Invasive Aspergillosis in Australia and New Zealand: 2017-2020 (92538)

SHioyen Tio 1 , Sharon CA Chen 2 , kate Hamilton 1 3 , Christopher Heath 4 , Alyssa Pradhan 2 , Arthur Morris 5 , Tony Korman 6 , Orla Morrissey 7 , Catriona Halliday 2 , Sarah Kidd 8 , Tim Spelman 9 , Nadiya Brell 10 , brendan McMullan 10 , Julia Clark 11 , Katerina Mitsakos 12 , Robyn Hardiman 12 , Phoebe Williams 13 , Anita campbell 14 , Justin Beardsley 15 , Sebastian van Hal 16 , Michelle Yong 1 , Leon Worth 1 , Monica Slavin 1
  1. Infectious Diseases , Peter MacCallum Cancer Centre , Mlebourne , Victoria , australia
  2. NSW Health Pathology, Sydney, NSW, Australia
  3. Infectious diseases , Westmead Hospital , Westmead , NSW , australia
  4. Infectious diseases , Fiona stanley Hospital , Perth , WA, australia
  5. Infectious diseases , Auckland city Hospital , Auckland , New Zealand
  6. Infectiousu diseases, Monash Health, Clayton, Mlebourne, Victoria , Australia
  7. Infectious diseases, Alfred Health and Monash Univerisity, Melbourne , Victoria , Australia
  8. National Mycology Reference Centre , SA Pathology , Adelaide , SA , Australia
  9. Department of Health services Research , Peter MaCallum Cancer Centre , Melbourne , Victoria , Australia
  10. Immunology and Infectious Diseases, Sydney Children’s Hospital, Sydney, NSW , Australia
  11. Infection Management service, Queensland Children’s Hospital, , Brisbane, Queensland , Australia
  12. Microbiology , New South Wales health Pathology, Royal North Shore Hospital , Sydney, NSW , Australia
  13. School of Public health, The University of Sydney, Sydney , NSW , Australia
  14. Department of Infectious Diseases, Perth Children’s Hospital, Perth, WA, Australia
  15. University of Sydney Infectious Diseases Institute, , Sydney , NSW , Australia
  16. Royal Prince Alfred Hospital , NSW health pathology , Sydney , NSW , Australia

Background: Emergent and new risks for invasive aspergillosis (IA) highlight the need for ongoing study of the epidemiology, including causative species, and outcomes of IA to inform clinical practice. Here we present the contemporary epidemiology and outcomes of IA in Australia and New Zealand and determine predictors of all-cause mortality.

 

Methods: A retrospective cohort study of proven and probable cases of IA was conducted at 10 tertiary hospitals (January 2017 to December 2020). Patient data, predisposing factors for IA, laboratory and imaging results and patient outcomes were collected. Aspergillus spp. were identified by standard laboratory methods. Cox proportional hazards regression was used to identify independent predictors of all-cause mortality at 90 days following diagnosis for the entire cohort and in patients with haematological malignancy (HM).

 

Results: Of 221 evaluable IA episodes (221 patients), 53 were ‘proven’ and 168, ‘probable’ infections. Median patient age was 61 years (IQR 51-69). Commonest patient co-morbidities were HM (49.8%) followed by solid organ transplantation and chronic lung disease (each 24.9%); 11 patients (5%) had no co-morbidity. Recent of immunosuppressive therapy was present in 80.1% of patients and neutropenia, 30%. Pulmonary IA was the most frequent (85.5%) with disseminated disease uncommon (3.6%). For 158 patients, Aspergillus fumigatus sensu stricto was the causative pathogen in 81% of cases, followed by A. niger (8.2%) A. flavus and A. terreus (each 6.3%). Cryptic species of A. fumigatus complex were rare (n=3). Pulmonary nodules were present in 56% cases but halo signs evident in 10.2%. All-cause 90-day mortality was 30.3% where HM and ICU admission predicted mortality (hazard ratio [HR] 1.85; 95% CI 1.01-3.37, p=0.04 and HR 4.61, 95% CI 0.36-1.23 P<0.001, respectively). In HM patients, chronic kidney disease also predicted death (P=0.03).

 

Conclusions: Emerging new risks for IA was recognised with 50% of cases occurring outside the HM setting including in patients with mild immunosuppression/no co-morbidity. Mortality remains high. The relatively high frequency of non-fumigatus Aspergillus pathogens is noteworthy.