Decreased Frequency and Improved Outcomes in Invasive Aspergillosis Caused by Aspergillus terreus After the Introduction of Anti-Mold Azole Agents: A 30-Year Study at a Tertiary Cancer Center

Invasive aspergillosis (IA) is a significant cause of morbidity and mortality in patients with hematological malignancy (HM) and hematopoietic stem cell transplant (HSCT) recipients. <i>Aspergillus terreus</i> is associated with worse outcomes than non-<i>terreus Aspergillus</i> species. Since the introduction of anti-mold azoles in 2002, there have been limited data on the etiology of IA. We retrospectively compared characteristics, antifungal treatments, and outcomes between patients with HM or HSCT infected with <i>A. terreus</i> and those with non-<i>terreus Aspergillus</i> between July 1993 and July 2023. We also examined trends over time in rates of <i>A. terreus</i> and outcomes of this infection. A total of 699 patients with culture-documented IA were analyzed, 537 with non-<i>terreus</i> species and 162 with <i>A. terreus</i>. Types of underlying malignancy, neutropenia, graft-versus-host disease, and anti-mold prophylaxis were similar between the groups. ICU stays and mechanical ventilation were more common among patients with <i>A. terreus</i> (<i>p</i> = 0.002 and 0.003, respectively). The rate of <i>A. terreus</i> decreased significantly from 35.9% during 1993-2003 to 11.2% during 2004-2013 and 16.7% during 2014-2023 (<i>p</i> < 0.0001 each). IA caused by <i>A. terreus</i> showed significant improvements in response to therapy and in overall and IA-associated mortality in the last two decades compared to the first (<i>p</i> < 0.0001). In conclusion, the increased use of anti-mold azoles after 2003 improved outcomes for HM patients with IA caused by <i>A. terreus</i>.