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    Factors affecting mortality in covid-19-associated pulmonary aspergillosis: an international ID-IRI study
    (2024) Şahin, Meyha; Yılmaz, Mesut; Mert, Ali; Emecen, Ahmet Naci; Rahman S. Al Maslamani, Muna A.; Mahmoud A. Hashim, Samar; Ittaman, Ajithkumar Valooparambil; Wadi Al Ramahi, Jamal; Gergely Szabo, Balint; Konopnicki, Deborah; Başkol Elik, Dilşah; Lakatos, Botond; Sipahi, Oğuz Reşat; Khedr, Reham; Jalal, Sabah; Pshenichnaya, Natalia; Magdalena, Dumitru Irina; El Kholy, Amani; Khan, Ejaz Ahmed; Alkan, Sevil; Hakamifard, Atousa; Sincan, Gülden; Esmaoğlu, Aliye; Makek, Mateja Jankovic; Gürbüz, Esra; Liskova, Anna; Albayrak, Ayşe; Stebel, Roman; Ünver Ulusoy, Tülay; Ripon, Rezaul Karim; Moroti, Ruxandra; Dascalu, Cosmin; Rashid, Naveed; Cortegiani, Andrea; Bahadır, Zeynep; Erdem, Hakan
    Background: This study aimed to identify factors that influence the mortality rate of patients with coronavirus disease (COVID-19)-associated pulmonary aspergillosis (CAPA). Methods: In this cross-sectional study, data from 23 centers across 15 countries, spanning the period of March 2020 to December 2021, were retrospectively collected. The study population comprised patients who developed invasive pulmonary aspergillosis while being treated for COVID-19 in the intensive care unit. Cox regression and decision tree analyses were used to identify factors associated with mortality in patients with CAPA. Results: A total of 162 patients (males, 65.4 %; median age: 64 [25th–75th: 54.0–73.8] years) were included in the study, of whom 113 died during the 90-day follow-up period. The median duration from CAPA diagnosis to death was 12 (25th–75th: 7–19) days. In the multivariable Cox regression model, an age of ?65 years (hazard ratio [HR]: 2.05, 95 % confidence interval [CI]: 1.37–3.07), requiring vasopressor therapy at the time of CAPA diagnosis (HR: 1.80, 95 % CI: 1.17–2.76), and receiving renal replacement therapy at the time of CAPA diagnosis (HR: 2.27, 95 % CI: 1.35–3.82) were identified as predictors of mortality. Decision tree analysis revealed that patients with CAPA aged ?65 years who received corticosteroid treatment for COVID-19 displayed higher mortality rates (estimated rate: 1.6, observed in 46 % of patients). Conclusion: This study concluded that elderly patients with CAPA who receive corticosteroids are at a significantly higher risk of mortality, particularly if they experience multiorgan failure.
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    Factors influencing mortality in covid-19-associated mucormycosis - the international ID-IRI study
    (2024) Şahin, Meyha; Yılmaz, Mesut; Mert, Ali; Naghili, Behrouz; Ravanbakhsh, Fatemeh; Varshochi, Mojtaba; Alavi Darazam, Ilad; Ebrahimi, Mohammad Javad; Moafi, Maral; Tehrani, Hamed Azhdari; Mahboob, Amjad; Rashid, Naveed; Khan, Ejaz Ahmed; Hakamifard, Atousa; Eser Karlıdağ, Gülden; Babamahmoodi, Abdolreza; El-Kholy, Amani; Mosawi, Sayed Hussain; Albayrak, Ayşe; Wadi Al Ramahi, Jamal; Addepalli, Syam Kumar; Balin, Şafak Özer; Khan, Asfandiyar; Pandya, Nirav; Gürbüz, Esra; Sincan, Gülden; Azami, Hadia; Dumlu, Rıdvan; Khedr, Reham; Ripon, Rezaul Karim; Alkan, Sevil; Köse, Şükran; Ceylan, Bahadır; Erdem, Hakan
    The emergence of COVID-19, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), triggered a global pandemic. Concurrently, reports of mucormycosis cases surged, particularly during the second wave in India. This study aims to investigate mortality factors in COVID-19-associated mucormycosis (CAM) cases, exploring clinical, demographic, and therapeutic variables across mostly Asian and partly African countries. A retrospective, cross-sectional analysis of CAM patients from 22 medical centers across eight countries was conducted, focusing on the first three months post-COVID-19 diagnosis. Data collected through the IDI-IR included demographics, comorbidities, treatments, and outcomes. A total of 162 CAM patients were included. The mean age was 54.29±13.04 years, with 54% male. Diabetes mellitus (85%) was prevalent, and 91% had rhino-orbital-cerebral mucormycosis (ROCM). Surgical debridement was performed in 84% of the cases. Mortality was 39%, with advanced age [Hazard Ratio (HR)=1.06, (p<0.001)], rituximab use (HR=21.2, p=0.05), diabetic ketoacidosis (HR=3.58, p=0.009) identified as risk factors. The mortality risk increases by approximately 5.6% for each additional year of age. Surgical debridement based on organ involvement correlated with higher survival (HR=8.81, p<0.001). The utilization of rituximab and diabetic ketoacidosis along with advancing age, has been associated with an increased risk of mortality in CAM patients. A combination of antifungal treatment and surgical intervention has demonstrated a substantial improvement in survival outcomes.
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    Prospective analysis of febrile neutropenia patients with bacteraemia: The results of an international ID-IRI study
    (NLM (Medline), 2023) Erdem, Hakan; Koçoğlu, Esra; Ankaralı, Handan; El-Sokkary, Rehab; Hakamifard, Atousa; Karaali, Rıdvan; Kulzhanova, Sholpan; Sirmatel, Fatma
    OBJECTIVES: Bacteraemia during the course of neutropenia is often fatal. We aimed to identify factors predicting mortality to have an insight into better clinical management. METHODS: The study has a prospective, observational design using pooled data from febrile neutropenia patients with bacteraemia in 41 centres in 16 countries. Polymicrobial bacteraemias were excluded. It was performed through the Infectious Diseases-International Research Initiative platform between 17 March 2021 and June 2021. Univariate analysis followed by a multivariate binary logistic regression model was used to determine independent predictors of 30-d in-hospital mortality (sensitivity, 81.2%; specificity, 65%). RESULTS: A total of 431 patients were enrolled, and 85 (19.7%) died. Haematological malignancies were detected in 361 (83.7%) patients. Escherichia coli (n = 117, 27.1%), Klebsiellae (n = 95, 22% %), Pseudomonadaceae (n = 63, 14.6%), Coagulase-negative Staphylococci (n = 57, 13.2%), Staphylococcus aureus (n = 30, 7%), and Enterococci (n = 21, 4.9%) were the common pathogens. Meropenem and piperacillin-tazobactam susceptibility, among the isolated pathogens, were only 66.1% and 53.6%, respectively. Pulse rate (odds ratio [OR], 1.018; 95% confidence interval [CI], 1.002-1.034), quick SOFA score (OR, 2.857; 95% CI, 2.120-3.851), inappropriate antimicrobial treatment (OR, 1.774; 95% CI, 1.011-3.851), Gram-negative bacteraemia (OR, 2.894; 95% CI, 1.437-5.825), bacteraemia of non-urinary origin (OR, 11.262; 95% CI, 1.368-92.720), and advancing age (OR, 1.017; 95% CI, 1.001-1.034) were independent predictors of mortality. Bacteraemia in our neutropenic patient population had distinctive characteristics. The severity of infection and the way to control it with appropriate antimicrobials, and local epidemiological data, came forward. CONCLUSIONS: Local antibiotic susceptibility profiles should be integrated into therapeutic recommendations, and infection control and prevention measures should be prioritised in this era of rapidly increasing antibiotic resistance.