Clinical and microbiological features and outcomes of mucormycosis in critically ill patients

Int J Infect Dis. 2021 Jul 3:S1201-9712(21)00555-5. doi: 10.1016/j.ijid.2021.06.066. Online ahead of print.

ABSTRACT

INTRODUCTION: Mucormycosis is a rare invasive fungal infection with high mortality in patients with severe underlying predisposing factors causing immunosuppression. The exact incidence of mucormycosis and the optimal therapeutic approach especially in severe cases is hard to determine due to the rarity of the disease. The new second generation triazole isavuconazole provides an alternative treatment option which might represent a potential benefit in severe cases.

MATERIAL AND METHODS: A retrospective case series of patients with a positive laboratory culture for Mucorales and consistent clinical findings who required intensive care treatment was conducted. Patient characteristics including demographics, comorbidities, microbiological analysis, specific antifungal therapy and clinical outcome were analyzed.

RESULTS: Fifteen critically-ill patients with detection of Mucorales between 2016 and 2019 were included, crude mortality rate was 100%. At time of diagnosis of mucormycosis, relevant medical immunosuppression was present in 80% and 53.3% had neutropenia. Manifestation of mucormycosis was pulmo-nary in 53.3%, rhino-orbital in 20% and disseminated in 26.7%. Notably, 40% of all pa-tients had received antifungal prophylaxis prior to mucormycosis mainly with posacon-azole due to underlying hematological malignancy thus possibly representing break-through infections. Antifungal therapy for invasive mucormycosis was administered in 80% with a median duration of 16 days.

CONCLUSION: In this retrospective cohort analysis of ICU patients the prognosis of mucormycosis was extremely poor. An aggressive strategy in diagnosis and treatment is essential for ICU patients with mucormycosis. Whether, combi-nation therapy in higher dosages or prompt surgery even in severe critically ill patients is beneficial should be further investigated.

PMID:34229089 | DOI:10.1016/j.ijid.2021.06.066