Universität zu Köln

Sprute, Rosanne ORCID: 0000-0003-2457-6437, Salmanton-Garcia, Jon, Sal, Ertan ORCID: 0000-0003-2761-2675, Malaj, Xhorxha ORCID: 0000-0003-1543-0532, Falces-Romero, Iker, Hatvani, Lorant ORCID: 0000-0003-0953-3201, Heinemann, Melina ORCID: 0000-0001-7762-4696, Klimko, Nikolai, Lopez-Soria, Leyre ORCID: 0000-0003-2335-8665, Meletiadis, Joseph, Shruti, Malik, Steinmann, Joerg, Seidel, Danila, Cornely, Oliver A. and Stemler, Jannik (2021). Characterization and outcome of invasive infections due to Paecilomyces variotii: analysis of patients from the FungiScope (R) registry and literature reports. J. Antimicrob. Chemother., 76 (3). S. 765 - 775. OXFORD: OXFORD UNIV PRESS. ISSN 1460-2091

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Abstract

Objectives: To provide a basis for clinical management decisions in Paecilomyces variotii infection. Methods: Unpublished cases of invasive P. variotii infection from the FungiScope (R) registry and all cases reported in the Literature were analysed.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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Sprute, Rosanne UNSPECIFIED orcid.org/0000-0003-2457-6437 UNSPECIFIED Salmanton-Garcia, Jon UNSPECIFIED UNSPECIFIED UNSPECIFIED Sal, Ertan UNSPECIFIED orcid.org/0000-0003-2761-2675 UNSPECIFIED Malaj, Xhorxha UNSPECIFIED orcid.org/0000-0003-1543-0532 UNSPECIFIED Falces-Romero, Iker UNSPECIFIED UNSPECIFIED UNSPECIFIED Hatvani, Lorant UNSPECIFIED orcid.org/0000-0003-0953-3201 UNSPECIFIED Heinemann, Melina UNSPECIFIED orcid.org/0000-0001-7762-4696 UNSPECIFIED Klimko, Nikolai UNSPECIFIED UNSPECIFIED UNSPECIFIED Lopez-Soria, Leyre UNSPECIFIED orcid.org/0000-0003-2335-8665 UNSPECIFIED Meletiadis, Joseph UNSPECIFIED UNSPECIFIED UNSPECIFIED Shruti, Malik UNSPECIFIED UNSPECIFIED UNSPECIFIED Steinmann, Joerg UNSPECIFIED UNSPECIFIED UNSPECIFIED Seidel, Danila UNSPECIFIED UNSPECIFIED UNSPECIFIED Cornely, Oliver A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Stemler, Jannik UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-601207
DOI:	10.1093/jac/dkaa481
Journal or Publication Title:	J. Antimicrob. Chemother.
Volume:	76
Number:	3
Page Range:	S. 765 - 775
Date:	2021
Publisher:	OXFORD UNIV PRESS
Place of Publication:	OXFORD
ISSN:	1460-2091
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language Infectious Diseases; Microbiology; Pharmacology & Pharmacy Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/60120