Browsing by Author "Freifeld, Alison G"

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    Invasive non-Aspergillus mold infections in transplant recipients, United States, 2001-2006.
    (Emerging infectious diseases, 2011-10) Park, Benjamin J; Pappas, Peter G; Wannemuehler, Kathleen A; Alexander, Barbara D; Anaissie, Elias J; Andes, David R; Baddley, John W; Brown, Janice M; Brumble, Lisa M; Freifeld, Alison G; Hadley, Susan; Herwaldt, Loreen; Ito, James I; Kauffman, Carol A; Lyon, G Marshall; Marr, Kieren A; Morrison, Vicki A; Papanicolaou, Genovefa; Patterson, Thomas F; Perl, Trish M; Schuster, Mindy G; Walker, Randall; Wingard, John R; Walsh, Thomas J; Kontoyiannis, Dimitrios P
    Recent reports describe increasing incidence of non-Aspergillus mold infections in hematopoietic cell transplant (HCT) and solid organ transplant (SOT) recipients. To investigate the epidemiology of infections with Mucorales, Fusarium spp., and Scedosporium spp. molds, we analyzed data from the Transplant-Associated Infection Surveillance Network, 23 transplant centers that conducted prospective surveillance for invasive fungal infections during 2001-2006. We identified 169 infections (105 Mucorales, 37 Fusarium spp., and 27 Scedosporium spp.) in 169 patients; 124 (73.4%) were in HCT recipients, and 45 (26.6%) were in SOT recipients. The crude 90-day mortality rate was 56.6%. The 12-month mucormycosis cumulative incidence was 0.29% for HCT and 0.07% for SOT. Mucormycosis incidence among HCT recipients varied widely, from 0.08% to 0.69%, with higher incidence in cohorts receiving transplants during 2003 and 2004. Non-Aspergillus mold infections continue to be associated with high mortality rates. The incidence of mucormycosis in HCT recipients increased substantially during the surveillance period.
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    Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database.
    (Clin Infect Dis, 2010-04-15) Kontoyiannis, Dimitrios P; Marr, Kieren A; Park, Benjamin J; Alexander, Barbara D; Anaissie, Elias J; Walsh, Thomas J; Ito, James; Andes, David R; Baddley, John W; Brown, Janice M; Brumble, Lisa M; Freifeld, Alison G; Hadley, Susan; Herwaldt, Loreen A; Kauffman, Carol A; Knapp, Katherine; Lyon, G Marshall; Morrison, Vicki A; Papanicolaou, Genovefa; Patterson, Thomas F; Perl, Trish M; Schuster, Mindy G; Walker, Randall; Wannemuehler, Kathleen A; Wingard, John R; Chiller, Tom M; Pappas, Peter G
    BACKGROUND: The incidence and epidemiology of invasive fungal infections (IFIs), a leading cause of death among hematopoeitic stem cell transplant (HSCT) recipients, are derived mainly from single-institution retrospective studies. METHODS: The Transplant Associated Infections Surveillance Network, a network of 23 US transplant centers, prospectively enrolled HSCT recipients with proven and probable IFIs occurring between March 2001 and March 2006. We collected denominator data on all HSCTs preformed at each site and clinical, diagnostic, and outcome information for each IFI case. To estimate trends in IFI, we calculated the 12-month cumulative incidence among 9 sequential subcohorts. RESULTS: We identified 983 IFIs among 875 HSCT recipients. The median age of the patients was 49 years; 60% were male. Invasive aspergillosis (43%), invasive candidiasis (28%), and zygomycosis (8%) were the most common IFIs. Fifty-nine percent and 61% of IFIs were recognized within 60 days of neutropenia and graft-versus-host disease, respectively. Median onset of candidiasis and aspergillosis after HSCT was 61 days and 99 days, respectively. Within a cohort of 16,200 HSCT recipients who received their first transplants between March 2001 and September 2005 and were followed up through March 2006, we identified 718 IFIs in 639 persons. Twelve-month cumulative incidences, based on the first IFI, were 7.7 cases per 100 transplants for matched unrelated allogeneic, 8.1 cases per 100 transplants for mismatched-related allogeneic, 5.8 cases per 100 transplants for matched-related allogeneic, and 1.2 cases per 100 transplants for autologous HSCT. CONCLUSIONS: In this national prospective surveillance study of IFIs in HSCT recipients, the cumulative incidence was highest for aspergillosis, followed by candidiasis. Understanding the epidemiologic trends and burden of IFIs may lead to improved management strategies and study design.