Invasive aspergillosis caused by Aspergillus terreus: an emerging opportunistic infection with poor outcome independent of azole therapy

Objectives: Invasive aspergillosis (IA) caused by Aspergillus terreus is a significant cause of morbidity and mor-tality in patients with haematological malignancy (HM). Very few data are available in this patient population to differentiate IA patients with A. terreus from those with non-terreus species of Aspergillus to compare outcomes. We retrospectively investigated 513 HMpatientswhowere treated for either definite or probable IA between June 1993 and August 2012 in a cancer centre. Methods:We compared baseline characteristics, antifungal therapies and outcomes between patients infected with A. terreus (n96, 18.7%) and those infected with non-terreus Aspergillus species (n335, 65.3%). Eighty-one patients with mixed or unspecified Aspergillus infections were excluded. Results: Breakthrough infections occurred more frequently in the A. terreus group (91 % versus 77%, P0.009). A. terreus infection was associated with a lower rate of final response to antifungal therapy (21 % versus 38%, P0.0015) and a higher rate of IA-associated mortality (51 % versus 30%, P,0.001). Multivariate analyses showed that these associations were independent of patients ’ clinical characteristics and the antifungal regi-mens they received. Factors independently associated with final response included treatment with azoles (OR 3.1, 95 % CI 1.9–5.0, P,0.0001) and Aspergillus species (A. terreus versus non-terreus Aspergillus species) (OR 0.5, 95 % CI 0.3–0.98, P0.043). Additionally, Aspergillus species and treatment with azoles were independ