SIMIFF study: Italian fungal registry of mold infections in hematological and non-hematological patients

We compared the risk factors, the diagnostic tools and the outcome of filamentous fungal infections (FFIs) in hematological patients (HAEs) and non-hematological patients (non-HAEs).Prospective surveillance (2009-2011) of proven and probable FFIs was implemented in 23 Italian hospitals.Out of 232 FFIs, 113 occurred in HAEs and 119 in non-HAEs. The most frequent infection was invasive aspergillosis (76.1 \% for HAEs, 56.3 \% for non-HAEs), and the localization was principally pulmonary (83.2 \% for HAEs, 74.8 \% for non-HAEs). Neutropenia was a risk factor for 89.4 \% HAEs; the main underlying condition was corticosteroid treatment (52.9 \%) for non-HAEs. The distribution of proven and probable FFIs was different in the two groups: proven FFIs occurred more frequently in non-HAEs, whereas probable FFIs were correlated with the HAEs. The sensitivity of the galactomannan assay was higher for HAEs than for non-HAEs (95.3 vs. 48.1 \%). The overall mortality rate was 44.2 \% among the HAEs and 35.3 \% among the non-HAEs. The etiology influenced the patient outcomes: mucormycosis was associated with a high mortality rate (57.1 \% for HAEs, 77.8 \% for non-HAEs).The epidemiological and clinical data for FFIs were not identical in the HAEs and non-HAEs. The differences should be considered to improve the management of FFIs according to the patients' setting.