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Active Surveillance Program to Increase Awareness on Invasive Fungal Diseases: the French RESSIF Network (2012 to 2018)

Stéphane Bretagne 1, 2, 3 Karine Sitbon 1, 3 Marie Desnos-Ollivier 1, 3 Dea Garcia-Hermoso 1, 3 Valérie Letscher-Bru 4 Sophie Cassaing 5 Laurence Millon 6 Florent Morio 7 Jean-Pierre Gangneux 8 Lilia Hasseine 9 Loïc Favennec 10 Estelle Cateau 11 Eric Bailly 12 Maxime Moniot 13 Julie Bonhomme 14 Nicole Desbois-Nogard 15 Taieb Chouaki 16 André Paugam 17 Bernard Bouteille 18 Marc Pihet 19, 20, 21 Frédéric Dalle 22 Odile Eloy 23 Milène Sasso 24 Magalie Demar 25 Patricia Mariani-Kurkdjian 26 Vincent Robert 27 Olivier Lortholary 1, 3, 28 Françoise Dromer 1, 3, * The French Mycoses Study Group
Abstract : The French National Reference Center for Invasive Mycoses and Antifungals leads an active and sustained nationwide surveillance program on probable and proven invasive fungal diseases (IFDs) to determine their epidemiology in France. Between 2012 and 2018, a total of 10,886 IFDs were recorded. The incidence increased slightly over time (2.16 to 2.36/10,000 hospitalization days, P = 0.0562) in relation with an increase of fungemia incidence (1.03 to 1.19/10,000, P = 0.0023), while that of other IFDs remained stable. The proportion of ≥65-year-old patients increased from 38.4% to 45.3% (P < 0.0001). Yeast fungemia (n = 5,444) was due mainly to Candida albicans (55.6%) with stable proportions of species over time. Echinocandins became the main drug prescribed (46.7% to 61.8%), but global mortality rate remained unchanged (36.3% at 1 month). Pneumocystis jirovecii pneumonia (n = 2,106) was diagnosed mostly in HIV-negative patients (80.7%) with a significantly higher mortality than in HIV-positive patients (21.9% versus 5.4% at 1 month, P < 0.0001). Invasive aspergillosis (n = 1,661) and mucormycosis (n = 314) were diagnosed mostly in hematology (>60% of the cases) with a global mortality rate of 42.5% and 59.3%, respectively, at 3 months and significant changes in diagnosis procedure over time. More concurrent infections were also diagnosed over time (from 5.4% to 9.4% for mold IFDs, P = 0.0115). In conclusion, we observed an aging of patients with IFD with a significant increase in incidence only for yeast fungemia, a trend toward more concurrent infections, which raises diagnostic and therapeutic issues. Overall, global survival associated with IFDs has not improved despite updated guidelines and new diagnostic tools. IMPORTANCE The epidemiology of invasive fungal diseases (IFDs) is hard to delineate given the difficulties in ascertaining the diagnosis that is often based on the confrontation of clinical and microbiological criteria. The present report underlines the interest of active surveillance involving mycologists and clinicians to describe the global incidence and that of the main IFDs. Globally, although the incidence of Pneumocystis pneumonia, invasive aspergillosis, and mucormycosis remained stable over the study period (2012 to 2018), that of yeast fungemia increased slightly. We also show here that IFDs seem to affect older people more frequently. The most worrisome observation is the lack of improvement in the global survival rate associated with IFDs despite the increasing use of more sensitive diagnostic tools, the availability of new antifungal drugs very active in clinical trials, and a still low/marginal rate of acquired in vitro resistance in France. Therefore, other tracks of improvement should be investigated actively.
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Soumis le : mercredi 4 mai 2022 - 13:32:21
Dernière modification le : samedi 21 mai 2022 - 03:47:59


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Stéphane Bretagne, Karine Sitbon, Marie Desnos-Ollivier, Dea Garcia-Hermoso, Valérie Letscher-Bru, et al.. Active Surveillance Program to Increase Awareness on Invasive Fungal Diseases: the French RESSIF Network (2012 to 2018). mBio, American Society for Microbiology, 2022, pp.e0092022. ⟨10.1128/mbio.00920-22⟩. ⟨hal-03658122⟩



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