1131. Characteristics and Risk Factors for Mortality in Hematologic Patients with Invasive Non-Aspergillus Mold Infections: A Single-Center 7-Year Cohort Study

Abstract

BackgroundSince anti-mold active azole prophylaxis has become a standard approach for patients with high-risk hematologic diseases, the epidemiology of invasive fungal infections (IFIs) has shifted toward non-Aspergillus molds in recent years. The aim of this study was to identify the epidemiology and characteristics of non-Aspergillus invasive mold infections (NAIMIs) in the real-world.MethodsProven/probable NAIMIs developed in patients with hematologic diseases were reviewed from January 2011 to January 2018 at the Catholic Blood and Marrow Transplantation Center.ResultsThere 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 nonmucormycosis at 6 weeks 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.ConclusionNAIMIs 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.Disclosures All authors: No reported disclosures.