Epidemiology and Clinical Features of Invasive Fungal Disease in a US Healthcare Network

Abstract

Background A better understanding of the epidemiology and clinical features of invasive fungal disease (IFD) is integral to improving outcomes. Here we aimed to describe the incidence, clinical features and outcomes of IFD in a large US healthcare network.Methods We developed a novel method of IFD cohort discovery to query all available records in the Intermountain Healthcare electronic data warehouse from 2006 to 2015 for clinical data associated with IFD (Figure 1). Resulting data were overlaid in 124 different combinations to identify high-probability IFD cases. The cohort was manually reviewed and exclusions applied. EORTC/MSG definitions were adapted to categorize IFD in a broad patient population. Linear regression was used to model variation in incidence over time.Results3,391 IFD episodes occurred in 3,171 patients. Mean incidence was 27.4 cases/100,000 patients per year (Figure 2). Estimated mean annual increase was 0.24 cases/100,000 patients (r2 = 0.09, P = 0.21). Candidiasis was most common (56%). Dimorphic fungi, primarily Coccidioides, comprised 24%, followed by aspergillosis (9%). Mean age was 50 years; pediatric cases accounted for 13%. 19.2% of patients had an active malignancy or primary immunodeficiency, 6.9% were transplant recipients, and 27.5% were on immunosuppression. Lymphopenia preceded IFD in 24.4% of patients. Hospital admission occurred in 75%; median length of stay was 12 days. All-cause mortality was 17% at 42 days and 28.6% at 1 year. 42-day mortality was highest in aspergillosis (27.5%), 20.5% for Candida, and lowest for dimorphic fungi (7.5%).Conclusion In this population, IFD was not uncommon, affected a broad spectrum of patients and had high observed mortality.Table 1: N % IFD episodes3391100Proven225966.6Probable86825.6Possible2647.8Age (mean, SD)50 (23.8)Male174451.4Charlson score (median, IQI)3 (1, 6)Any malignancy46113.6Leukemia/lymphoma2116.2Allogeneic BMT1063.1Autologous BMT160.5Solid organ transplant792.3Other (HIV, etc.)55116.2IS medication93227.5Lymphopenia82824.4Neutropenia2587.6Hospitalization252974.6Length of stay, days (median, IQI)12 (5, 26)42-day mortality57517.01-year mortality97128.6BMT-bone marrow transplant; IS-immunosuppressiveFigure 1.Cohort discovery flowchart.Figure 2.Trends in invasive fungal disease incidence.Disclosures B. Webb, Astellas Pharma Global Development, Inc.: Grant Investigator, Research grant. J. Ferraro, Astellas Pharma Global Development, Inc.: Grant Investigator, Research support. S. Rea, Astellas Pharma Global Development, Inc.: Grant Investigator, Research support. J. Kammerer, Astellas Pharma Global Development, Inc..: Employee, Salary. S. Kaufusi, Astellas Pharma Global Development, Inc.: Grant Investigator, Research support. B. Goodman, Astellas Pharma Global Development, Inc.: Grant Investigator, Research support. G. Martin, Astellas Pharma Global Development, Inc.: Grant Investigator, Research support. J. Spalding, Astellas Pharma Global Development, Inc.: Employee, Salary