Table 1.
Patient Demographic Characteristics, Underlying Conditions, Health Care Utilization, Treatment, and Outcomes in an Active Surveillance System for Invasive Mold Disease—Georgia, 2017–2019a
| Characteristic | Total (N = 304) | All IMD Cases vs Noncases | IMD Cases (MSG vs Non-MSG) | ||||
|---|---|---|---|---|---|---|---|
| All Cases (n = 104) | Noncases (n = 200) | P Value | MSG Case (n = 41) | Non-MSG Case (n = 63) | P Value | ||
| Demographic characteristics | |||||||
| Age, median (IQR), y | 61 (50–70) | 60 (46–66) | 62 (51–71) | .056 | 54 (44–67) | 62 (52–66) | .261 |
| Male sex | 182 (59.9) | 69 (66.3) | 113 (56.5) | .109 | 25 (61.0) | 44 (69.8) | .399 |
| Race | .301 | .162 | |||||
| Black | 145 (47.7) | 53 (51.0) | 92 (46.0) | .468 | 23 (56.1) | 30 (47.6) | .428 |
| White | 126 (41.4) | 40 (38.5) | 86 (43.0) | .464 | 12 (29.3) | 28 (44.4) | .150 |
| Otherb | 14 (4.6) | 7 (6.7) | 7 (3.5) | .250 | 5 (12.2) | 2 (3.2) | .109 |
| Unknown | 19 (6.3) | 4 (3.8) | 15 (7.5) | .318 | 1 (2.4) | 3 (4.8) | >.999 |
| Ethnicity | .950 | .657 | |||||
| Hispanic or Latino | 12 (3.9) | 4 (3.8) | 8 (4.0) | >.999 | 1 (2.4) | 3 (4.8) | >.999 |
| Not Hispanic or Latino | 275 (90.5) | 95 (91.3) | 180 (90.0) | .838 | 39 (95.1) | 56 (88.9) | .477 |
| Unknown | 17 (5.6) | 5 (4.8) | 12 (6.0) | .796 | 1 (2.4) | 4 (6.3) | .646 |
| Site of infection or colonization | .364 | .045 | |||||
| Pulmonary | 183 (60.2) | 66 (63.5) | 117 (58.5) | .459 | 23 (56.1) | 43 (68.3) | .220 |
| ENT | 46 (15.1) | 17 (16.3) | 29 (14.5) | .736 | 10 (24.4) | 7 (11.1) | .103 |
| Cutaneous or deep tissue | 41 (13.5) | 9 (8.7) | 32 (16.0) | .080 | 1 (2.4) | 8 (12.7) | .085 |
| Other body sitec | 34 (11.2) | 12 (11.5) | 22 (11.0) | >.999 | 7 (17.1) | 5 (7.9) | .211 |
| Clinical characteristics and risk factors for invasive mold diseased | |||||||
| MSG clinical and host factors | |||||||
| ≥1 clinical and host factor | 28 (9.2) | 28 (26.9) | 0 (0.0) | <.001 | 28 (68.3) | 0 (0.0) | <.001 |
| ≥1 host factor | 92 (30.3) | 61 (58.7) | 31 (15.5) | <.001 | 31 (75.6) | 30 (47.6) | .008 |
| ≥1 clinical factor | 53 (17.4) | 39 (37.5) | 14 (7.0) | <.001 | 31 (75.6) | 8 (12.7) | <.001 |
| Hematologic malignancy | 33 (10.9) | 25 (24.0) | 8 (4.0) | <.001 | 16 (39.0) | 9 (14.3) | .005 |
| Leukemia | 14 (4.6) | 11 (10.6) | 3 (1.5) | <.001 | 7 (17.1) | 4 (6.3) | .107 |
| Lymphoma | 15 (4.9) | 10 (9.6) | 5 (2.5) | .010 | 5 (12.2) | 5 (7.9) | .510 |
| Multiple myeloma | 2 (0.7) | 2 (1.9) | 0 (0.0) | .116 | 1 (2.4) | 1 (1.6) | >.999 |
| Other hematological malignancies | 3 (1.0) | 3 (2.9) | 0 (0.0) | .039 | 3 (7.3) | 0 (0.0) | .059 |
| Solid organ malignancy | 29 (9.5) | 8 (7.7) | 21 (10.5) | .539 | 2 (4.9) | 6 (9.5) | .475 |
| Hematopoietic stem cell transplant | 9 (3.0) | 8 (7.7) | 1 (0.5) | .001 | 5 (12.2) | 3 (4.8) | .259 |
| Solid organ transplant | 28 (9.2) | 21 (20.2) | 7 (3.5) | <.001 | 8 (19.5) | 13 (20.6) | >.999 |
| Graft-vs-host disease within previous 90 d | 3 (1.0) | 2 (1.9) | 1 (0.5) | .270 | 1 (2.4) | 1 (1.6) | >.999 |
| Neutropenia within previous 30 d | 24 (7.9) | 20 (19.2) | 4 (2.0) | <.001 | 11 (26.8) | 9 (14.3) | .132 |
| Lymphopenia documented within previous 30 d | 79 (26.0) | 47 (45.2) | 32 (16.0) | <.001 | 23 (56.1) | 24 (38.1) | .106 |
| HIV | 20 (6.6) | 6 (5.8) | 14 (7.0) | .810 | 2 (4.9) | 4 (6.3) | >.999 |
| Advanced HIV | 13 (4.3) | 4 (3.8) | 9 (4.5) | >.999 | 2 (4.9) | 2 (3.2) | .646 |
| Chronic pulmonary disease | 101 (33.2) | 30 (28.8) | 71 (35.5) | .252 | 8 (19.5) | 22 (34.9) | .121 |
| COPD or asthma | 55 (18.1) | 14 (13.5) | 41 (20.5) | 5 (12.2) | 9 (14.3) | ||
| Chronic pulmonary disease besides COPD/asthmae | 48 (15.8) | 16 (15.4) | 32 (16.0) | 2 (4.9) | 14 (22.2) | ||
| Chronic pulmonary infectionsf | 14 (4.6) | 3 (2.9) | 11 (5.5) | 2 (4.9) | 1 (1.6) | ||
| Influenza | 3 (1.0) | 2 (1.9) | 1 (0.5) | .270 | 0 (0.0) | 2 (3.2) | .518 |
| Diabetes | 80 (26.3) | 36 (34.6) | 44 (22.0) | .020 | 13 (31.7) | 23 (36.5) | .677 |
| Cirrhosis | 5 (1.6) | 2 (1.9) | 3 (1.5) | >.999 | 0 (0.0) | 2 (3.2) | .518 |
| End-stage renal disease | 23 (7.6) | 12 (11.5) | 11 (5.5) | .069 | 6 (14.6) | 6 (9.5) | .533 |
| Autoimmune disease or inherited immunodeficiencyg | 22 (7.2) | 8 (7.7) | 14 (7.0) | .819 | 2 (4.9) | 6 (9.5) | .475 |
| Severe burn within previous 90 d | 7 (2.3) | 5 (4.8) | 2 (1.0) | .049 | 2 (4.9) | 3 (4.8) | >.999 |
| Medications within previous 90 d | |||||||
| Corticosteroids | 66 (21.7) | 41 (39.4) | 25 (12.5) | <.001 | 21 (51.2) | 20 (31.7) | .065 |
| Prolonged, high-dose corticosteroids (20 mg prednisone daily or bioequivalent, ≥1 wk) |
33 (10.9) | 21 (20.2) | 12 (6.0) | <.001 | 11 (26.8) | 10 (15.9) | .214 |
| Cytotoxic chemotherapy | 19 (6.2) | 14 (13.5) | 5 (2.5) | <.001 | 11 (26.8) | 3 (4.8) | .002 |
| Transplant immunosuppressive drugs | 44 (14.5) | 33 (31.7) | 11 (5.5) | <.001 | 14 (34.1) | 19 (30.2) | .673 |
| Other immunosuppressive drugs, including biologics and targeted/designer drugs | 17 (5.6) | 9 (8.7) | 8 (4.0) | .115 | 6 (14.6) | 3 (4.8) | .150 |
| Treatments and clinical outcomes | |||||||
| Mold-active antifungal drug therapyh | 113 (37.2) | 99 (95.2) | 14 (7.0) | <.001 | 36 (87.8) | 63 (100.0) | .008 |
| Amphotericin B | 21 (6.9) | 20 (19.2) | 1 (0.5) | <.001 | 12 (29.3) | 8 (12.7) | .044 |
| Echinocandin | 22 (7.2) | 18 (17.3) | 4 (2.0) | <.001 | 8 (19.5) | 10 (15.9) | .791 |
| Isavuconazole | 44 (14.5) | 40 (38.5) | 4 (2.0) | <.001 | 16 (39.0) | 24 (38.1) | >.999 |
| Itraconazole | 3 (1.0) | 2 (1.9) | 1 (0.5) | .270 | 1 (2.4) | 1 (1.6) | >.999 |
| Posaconazole | 20 (6.6) | 19 (18.3) | 1 (0.5) | <.001 | 9 (22.0) | 10 (15.9) | .448 |
| Voriconazole | 48 (15.8) | 42 (40.4) | 6 (3.0) | <.001 | 16 (39.0) | 26 (41.3) | .841 |
| Inpatient hospitalizationi | 187 (61.5) | 91 (87.5) | 96 (48.0) | <.001 | 37 (90.2) | 54 (85.7) | .559 |
| Admission to ICUi | 84 (27.6) | 45 (43.3) | 39 (19.5) | <.001 | 18 (43.9) | 27 (42.9) | >.999 |
| Died in hospital (among hospitalized patients) | 34 (18.2) | 26 (28.6) | 8 (8.3) | <.001 | 10 (27.0) | 16 (29.6) | .818 |
| 90-d mortality | 50 (16.4) | 34 (32.7) | 16 (8.0) | <.001 | 12 (29.3) | 22 (34.9) | .670 |
Abbreviations: ENT, ear, nose, and throat; ICU, intensive care unit; IMD, invasive mold disease; IQR, interquartile range; MSG, European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group; NTM, nontuberculous mycobacterial infection.
Data are presented as No. (%) or median (interquartile range). P values were calculated using the Fisher exact test for categorical variables and the Kruskal-Wallis H test for continuous variables.
Among the 14 patients whose race was categorized as other, 9 were Asian, 3 were Native Hawaiian or other Pacific Islander, and 2 were American Indian/Alaska Native.
Among IMD patients, other sites of infection included central nervous system (n = 3), eye (n = 3), disseminated (n = 2), aortic valve (n = 1), and other/unspecified (n = 3).
Underlying medical conditions and treatments were present within 2 years before the date of incident mold specimen collection, unless otherwise specified. Patients could have multiple underlying conditions. Because diagnosis of an MSG-proven case is based solely on histopathology or culture data, patients with MSG-proven cases could lack MSG host or clinical risk factors.
Other chronic pulmonary diseases in IMD patients included bronchiectasis (n = 5), interstitial lung disease (n = 5), sarcoidosis (n = 2), pulmonary fibrosis (n = 1), bronchiolitis obliterans (n = 1), chronic respiratory failure from an unspecified cause (n = 1), and other (n = 1).
Three IMD patients had a diagnosis of NTM infection; 1 patient was diagnosed with both tuberculosis and NTM infection.
Among IMD patients, autoimmune conditions or inherited immunodeficiencies included rheumatoid arthritis (n = 3), antisynthetase syndrome (n = 1), primary biliary cholangitis (n = 1), primary immunodeficiency with T-cell defect (n = 1), mucous membrane pemphigoid (n = 1), unspecified connective tissue disease (n = 1), and scleroderma (n = 1).
Mold-active antifungal therapy was defined as receipt of treatment (ie, not prophylaxis) with amphotericin, anidulafungin, caspofungin, flucytosine, isavuconazole, itraconazole, micafungin, posaconazole, or voriconazole within 3 days before to 90 days after incident specimen collection. Among the 14 patients without an IMD case who received mold-active antifungal treatment, 4 had aspergilloma and 1 had allergic bronchopulmonary aspergillosis. For 8 patients, the mold-active antifungal treatment was stopped because the clinical team caring for the patient determined that the patient’s positive mold test(s) likely represented laboratory contamination or colonization; 1 patient received an echinocandin for invasive candidiasis but was not believed by the clinical team to have an IMD.
Inpatient hospitalization or ICU stay within 60 days after the date of incident specimen collection.