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Observational Study
. 2024 Aug;67(8):e13781.
doi: 10.1111/myc.13781.

Revision of antifungal strategies definitions for invasive fungal infections (proven/probable/possible) in 461 patients with haematological malignancies (REDEFI-SEIFEM)

Criscuolo Marianna  1 , Bonanni Matteo  1   2 , Piciocchi Alfonso  3 , Farina Francesca  4 , Verga Luisa  5 , Marchesi Francesco  6 , Basilico Claudia  7 , Del Principe Maria Ilaria  8 , Tisi Maria Chiara  9 , Cattaneo Chiara  10 , Picardi Marco  11 , Bonuomo Valentina  12   13 , Fracchiolla Nicola  14 , Candoni Anna  15 , Perruccio Katia  16 , Stanzani Marta  17 , Larici Anna Rita  2   18 , Sanguinetti Maurizio  19   20 , Busca Alessandro  21 , Pagano Livio  1   2 ; SEIFEM (Sorveglianza Epidemiologica Infezioni nelle Emopatie Maligne) group
Collaborators, Affiliations
Observational Study

Revision of antifungal strategies definitions for invasive fungal infections (proven/probable/possible) in 461 patients with haematological malignancies (REDEFI-SEIFEM)

Criscuolo Marianna et al. Mycoses. 2024 Aug.

Abstract

Background: Invasive fungal infections (IFI) are a relevant cause of morbidity and mortality among patients with haematological neoplasms (HMs). Since 2002, a classification of IFI based on host factors, clinical and radiological features and mycological tests was published for research purpose.

Objectives: These criteria are widely used in clinical practice to identify patients at risk for IFI. The aim of the study was to evaluate the clinical applicability of EORTC/MSG 2008 criteria for the diagnosis of IFI in daily practice.

Patients/methods: This multicentre, non-interventional, observational, prospective study gathered all consecutive inpatients with HMs in which an intravenous antifungal treatment was started. Exclusion criteria were a previous or concomitant transplant procedure, outpatient status and oral antifungal therapy. EORTC/MSG 2008 criteria were used to classify patients at the beginning of antifungal therapy and at 30 days. An independent board reviewed the classification of IFI given by local clinicians at T0 and T30.

Results: The highest percentage of agreement was found for possible IFI (96%), while a lower agreement was reported for proven IFI (74%), and the highest variability was observed for probable IFI (56%). At T30, the board re-evaluation confirmed a strict agreement for possible IFI only (98%). Among 306 patients classified as possible, 156 (51%) patients showed non-typical radiological findings and 45 (15%) patients presented host factors only.

Conclusions: In real life, the EORTC/MSG criteria can be applicable only for possible IFI. As non-typical radiological findings are reported in possible IFI, introducing a new IFI category should be considered.

Keywords: antifungal therapy; haematological neoplasms; invasive fungal infections; possible IFI; probable IFI; proven IFI.

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References

REFERENCES

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