Current Epidemiology and Infection Characteristics of Non- Aspergillus Mold Infections: A Multicenter Study in Australia and New Zealand

BACKGROUND: Understanding the epidemiology of invasive non-Aspergillus mold infections is essential to inform effective therapy. This study aimed to determine the epidemiology and infection characteristics of non-Aspergillus mold infections in Australasia. METHODS: A 21-center, retrospective study of proven/probable non-Aspergillus mold infections from 2016 to 2023 was conducted in Australia and New Zealand. Data collected included demographic, clinical, microbiological, treatment, and outcome information through 180 days of follow-up. RESULTS: Of 421 cases, 346 (82.2%) were proven infections and 315 (74.8%) were localized. Lung (n = 150, 35.6%) was the most common site of infection. Twenty cases (4.8%) were due to >1 non-Aspergillus mold pathogen, resulting in 443 isolates in total. Dematiaceous molds, inclusive of Lomentospora prolificans (n = 96 of 443, 21.7%), Scedosporium spp. (n = 87 of 443, 19.6%), and other dematiaceous molds of various genera (n = 48 of 443, 10.8%), were the most common (n = 231 of 443, 52.1%), followed by Mucorales (n = 141 of 443, 31.8%). Common underlying conditions were hematological malignancy (n = 146, 34.7%) and diabetes mellitus (n = 122, 29.0%), while 68 cases (16.2%) had no comorbidities. One-third (n = 138, 32.8%) of patients received antifungal prophylaxis 30 days before non-Aspergillus mold diagnosis, and L. prolificans was the most common cause of breakthrough infections (P < .001). All-cause 90-day mortality was 31.4% (n = 132 of 421), with higher mortality observed in L. prolificans (n = 51 of 89, 57.3%) and Mucorales (n = 56 of 129, 43.4%) infections. CONCLUSIONS: Lomentospora prolificans, Scedosporium spp., and Mucorales are the most frequent non-Aspergillus mold pathogens in Australasia, with other emerging species and mixed infections encountered. Mortality from L. prolificans and Mucorales infections remains high.