Multicenter Retrospective Study of Invasive Fusariosis in Intensive Care Units, France

Abstract

Invasive fusariosis can be life-threatening, especially in immunocompromised patients who require intensive care unit (ICU) admission. We conducted a multicenter retrospective study to describe clinical and biologic characteristics, patient outcomes, and factors associated with death and response to antifungal therapy. We identified 55 patients with invasive fusariosis from 16 ICUs in France during 2002----2020. The mortality rate was high (56%). Fusariosis-related pneumonia occurred in 76% of patients, often leading to acute respiratory failure. Factors associated with death included elevated sequential organ failure assessment score at ICU admission or history of allogeneic hematopoietic stem cell transplantation or hematologic malignancies. Neither voriconazole treatment nor disseminated fusariosis were strongly associated with response to therapy. Invasive fusariosis can lead to multiorgan failure and is associated with high mortality rates in ICUs. Clinicians should closely monitor ICU patients with a history of hematologic malignancies or stem cell transplantation because of higher risk for death.

Keywords: France; Fusarium; antimicrobial resistance; fungi; hematologic malignancy; intensive care unit; invasive fusariosis.

Figure 1

Flowchart for patient inclusion in a multicenter retrospective study of invasive fusariosis in ICUs, France. *Colonization by Fusarium defined as patient not meeting the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group or National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria for proven or probable invasive fungal diseases (7). ICU, intensive care unit.

Figure 2

Main clinical manifestations among patients in a multicenter retrospective study of invasive fusariosis in intensive care units, France. The figure was partly generated using Servier Medical Art (https://smart.servier.com), licensed under a Creative Commons Attribution 3.0 unported license.

Figure 3

Thoracic computed tomography scans from patients included in a multicenter retrospective study of invasive fusariosis in intensive care units, France, showing findings of fusariosis-related pneumonia. A) Unilateral consolidations (asterisk); B) ground glass opacities (triangle); C) 7-mm nodule (arrow) and bilateral pleural effusion.

Figure 4

Cumulative incidence of death among patients with and without history of hematologic malignancies and allo-HSCT in a multicenter retrospective study of invasive fusariosis in ICUs, France. Calculations used Fisher exact test (p = 0.017). Chart shows 14-day and 28-day death rates. Allo-HSCT, allogeneic hematopoietic stem cell transplant; ICU, intensive care unit.