Primary prophylaxis of bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematologic malignancies and solid tumors: 2020 updated guidelines of the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (AGIHO/DGHO)

Hematologic and oncologic patients with chemo- or immunotherapy-related immunosuppression are at substantial risk for bacterial infections and Pneumocystis jirovecii pneumonia (PcP). As bacterial resistances are increasing worldwide and new research reshapes our understanding of the interactions between the human host and bacterial commensals, administration of antibacterial prophylaxis has become a matter of discussion. This guideline constitutes an update of the 2013 published guideline of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). It gives an overview about current strategies for antibacterial prophylaxis in cancer patients while taking into account the impact of antibacterial prophylaxis on the human microbiome and resistance development. Current literature published from January 2012 to August 2020 was searched and evidence-based recommendations were developed by an expert panel. All recommendations were discussed and approved in a consensus conference of the AGIHO prior to publication. As a result, we present a comprehensive update and extension of our guideline for antibacterial and PcP prophylaxis in cancer patients

Prognostic factors in 264 adults with invasive Scedosporium spp. and Lomentospora prolificans infection reported in the literature and FungiScope

Invasive Scedosporium spp. and Lomentospora prolificans infections are an emerging threat in immunocompromised and occasionally in healthy hosts. Scedosporium spp. is intrinsically resistant to most, L. prolificans to all the antifungal drugs currently approved, raising concerns about appropriate treatment decisions. High mortality rates of up to 90% underline the need for comprehensive diagnostic workup and even more for new, effective antifungal drugs to improve patient outcome. For a comprehensive analysis, we identified cases of severe Scedosporium spp. and L. prolificans infections from the literature diagnosed in 2000 or later and the FungiScopeVR registry. For 208 Scedosporium spp. infections solid organ transplantation (n¼58, 27.9%) and for 56 L. prolificans infection underlying malignancy (n¼28, 50.0%) were the most prevalent risk factors. L. prolificans infections frequently presented as fungemia (n¼26, 46.4% versus n¼12, 5.8% for Scedosporium spp.). Malignancy, fungemia, CNS and lung involvement predicted worse outcome for scedosporiosis and lomentosporiosis. Patients treated with voriconazole had a better overall outcome in both groups compared to treatment with amphotericin B formulations. This review discusses the epidemiology, prognostic factors, pathogen susceptibility to approved and investigational antifungals, and treatment strategies of severe infections caused by Scedosporium spp. and L. prolificansWe thank Sabine Wrackmeyer for her private donation to support the projec

Invasive infections due to Saprochaete and Geotrichum species: Report of 23 cases from the FungiScope Registry

Saprochaete and Geotrichum spp. are rare emerging fungi causing invasive fungal diseases in immunosuppressed patients and scarce evidence is available for treatment decisions. Among 505 cases of rare IFD from the FungiScope registry, we identified 23 cases of invasive infections caused by these fungi reported from 10 countries over a 12-year period. All cases were adults and previous chemotherapy with associated neutropenia was the most common co-morbidity. Fungaemia was confirmed in 14 (61%) cases and deep organ involvement included lungs, liver, spleen, central nervous system and kidneys. Fungi were S.capitata (n=14), S.clavata (n=5), G.candidum (n=2) and Geotrichum spp. (n=2). Susceptibility was tested in 16 (70%) isolates. All S.capitata and S.clavata isolates with the exception of one S.capitata (MIC 4mg/L) isolate had MICs>32mg/L for caspofungin. For micafungin and anidulafungin, MICs varied between 0.25 and >32mg/L. One case was diagnosed postmortem, 22 patients received targeted treatment, with voriconazole as the most frequent first line drug. Overall mortality was 65% (n=15). Initial echinocandin treatment was associated with worse outcome at day 30 when compared to treatment with other antifungals (amphotericin B +/- flucytosine, voriconazole, fluconazole and itraconazole) (P=.036). Echinocandins are not an option for these infections

FungiScope (TM) - Global Emerging Fungal Infection Registry

Rare invasive fungal diseases (IFD) are challenging for the treating physicians because of their unspecific clinical presentation, as well as the lack of standardised diagnostic and effective treatment strategies. Late onset of treatment and inappropriate medication is associated with high mortality, thus, urging the need for a better understanding of these diseases. The purpose of FungiScope (TM) is to continuously collect clinical information and specimens to improve the knowledge on epidemiology and eventually improve patient management of these orphan diseases. FungiScope (TM) was founded in 2003, and today, collaborators from 66 countries support the registry. So far, clinical data of 794 cases have been entered using a web-based approach. Within the growing network of experts, new collaborations developed, leading to several publications of comprehensive analyses of patient subgroups identified from the registry. Data extracted from FungiScope (TM) have also been used as the sole control group for the approval of a new antifungal drug. Due to the rarity of these diseases, a global registry is an appropriate method of pooling the scarce and scattered information. Joining efforts across medical specialities and geographical borders is key for researching rare IFD. Here, we describe the structure and management of the FungiScope (TM) registry

FungiScope - Registre Mondial d’Infections Fongiques Invasives

FungiScopeTM - Enregistrement Global d‘Infections Fongiques Émergentes a été créé en 2003 avec l’objectif d‘améliorer la connaissance de l‘épidémiologie, les manifestations cliniques et les stratégies pour le traitement des infections invasives appelées «fonge émergents». Depuis sa création, des centres de 64 pays se sont associés à l‘initiative FungiScopeTM et plus de 650 cas ont été documentés. Les résultats du projet ont été présentés lors de conférences internationales et publiés dans multiples revues scientifiques. Mais FungiScopeTM est plus qu‘un simple outil pour l´enregistrement des cas cliniques: cette initiative offre un soutien pour le diagnostic, le recueilet l‘identification d’échantillons et fournit un moteur de recherche pour la base de données

FungiScope - Registro de Enfermedades Fúngicas Emergentes

FungiScopeTM - Registro Global de Infecciones Fúngicas Emergentes, fue establecido en el año 2003 con el objetivo de mejorar el conocimiento de la epidemiología, las manifestaciones clínicas y las estrategias para el tratamiento de infecciones invasivas CAUSADAS por los llamados “hongos emergentes”. Desde sus inicios, centros de 64 países se han unido a la iniciativa de FungiScopeTM y se han documentado más de 650 casos. Los resultados del proyecto han sido presentados en conferencias internacionales y publicados en revistas científicas indexadas. FungiScopeTM es más que un simple registro de casos clínicos dado que ofrece apoyo para el diagnóstico, recolección e identificación de muestras y proporciona una base de datos clínicos de acceso público

FungiScope - Registro Globale delle Infezioni Fungine Invasive

FungiScopeTM - Registro Globale delle Infezioni Fungine Emergenti è stato fondato nel 2003 con l‘obiettivo di migliorare le conoscenze di epidemiologia, la conoscenza delle manifestazioni cliniche e le strategie per il trattamento delle infezioni da funghi emergenti. Fin dalla sua istituzione, centri di 64 paesi hanno aderito all‘iniziativa FungiScopeTM e più di 650 casi sono stati documentati. I risultati del progetto sono stati presentati in conferenze internazionali e pubblicati su riviste scientifiche. FungiScopeTM è più di una semplice registrazione di casi clinici perché fornisce supporto per la diagnosi, la raccolta e l‘identificazione dei funghi, e offre un motore di ricerca per i dati clinici

Bakterielle Infektionen und Pneumocystis jirovecii Pneumonie - Prophylaxe

Patient*innen mit hämatologischen Erkrankungen und soliden Tumoren haben ein erhöhtes Risiko für bakterielle Infektionen und für Pneumonien verursacht durch Pneumocystis jirovecii (PjP). Dies betrifft vor allem die Zeit der Neutropenie nach Chemo- oder Immuntherapie induzierter Immunsuppression, wobei unter Berücksichtigung der erwarteten Neutropeniedauer sowie patienten-individueller Risikofaktoren zwischen Patient*innen mit hohem und niedrigem Infektionsrisiko unterschieden wird. Eine antibiotische Prophylaxe kann das Risiko für Fieber und Infektion bei Hochrisiko-Patient*innen reduzieren, trägt aber nicht sicher zur Reduktion der Mortalität bei. Vor dem Hintergrund einer zunehmenden Resistenzbildung sowie relevanter Nebenwirkungen sollte der Einsatz einer antibakteriellen medikamentösen Prophylaxe sorgfältig im Hinblick auf möglichen Nutzen und Risiko abgewogen werden. Die Leitlinie „Primary prophylaxis of bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematologic malignancies and solid tumors: 2020 updated guidelines of the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (AGIHO/DGHO)“ gibt eine Übersicht zur Prophylaxe von bakteriellen Infektionen und der Pneumocystis jirovecii Pneumonie (PjP) bei Patient*innen mit hämatologischen und soliden Neoplasien. Grundlagen für die Empfehlungen sind eine systemische Literaturrecherche, die einheitliche Bewertung der Evidenzstärke und ein Konsensfindungsprozess, der für die aktuelle Leitlinie im August 2020 abgeschlossen wurde. Die vorliegende Version ist eine Zusammenfassung der wichtigsten Empfehlungen. Kriterien der Evidenzbewertung und der Konsensfindung sind im Kapitel Infektionen bei Patienten mit hämatologischen und onkologischen Erkrankungen dargestellt