Zygomycosis in a Tertiary-Care Cancer Center in the era of Aspergillus-active antifungal therapy:: A case-control observational study of 27 recent cases
Zygomycosis in a Tertiary-Care Cancer Center in the era of Aspergillus-active antifungal therapy:: A case-control observational study of 27 recent cases
复制标题
DOI：
10.1086/428780
复制
发表时间：
2005-04-15
影响因子：
6.4
通讯作者：
Raad, II
中科院分区：
文献类型：
--
作者：
Kontoyiannis, DP;Lionakis, MS;Raad, II
背景轶事证据表明，在免疫抑制患者中使用伏立康唑（VRC）与真菌病的增加有关。我们对真菌病患者（A组;）进行了前瞻性监测，并将其与同期侵袭性曲霉病患者（B组; n = 54）和匹配的同期无真菌感染的高危患者（C组; n = 54）进行了比较。我们还对接合菌进行了分子分型和体外药敏试验。几乎所有的真菌病患者要么有白血病（n = 14）或异基因骨髓移植受体（n = 13）。接合菌分离株（其中74%是根霉属）有不同的分子指纹图谱，所有的VRC抗性。在A组和C组的多变量分析中，（比值比[OR]，10.37 [95%置信区间{CI}]，2.76-38.97]; P = .001），糖尿病（OR，8.39 [95%CI，2.04-34.35]; P = 0.003）和营养不良（OR，3.70 [95%CI，1.03-13.27]; P = 0.045）被发现是真菌病的独立危险因素。真菌病患者之间（排除6例混合霉菌感染患者后）和曲霉病患者，VRC预防（OR，20.30 [95% CI，3.85-108.15]; P = .0001）和鼻窦炎（OR，76.72 [95%CI，6.48-908.15]; P = 0.003）是唯一有利于真菌病诊断的因素。免疫抑制的患者在接受VRC预防治疗时发生鼻窦炎，应考虑接合菌病，尤其是糖尿病和营养不良的患者。
Background. Anecdotal evidence suggests a rise in zygomycosis in association with voriconazole (VRC) use in immunosuppressed patients.Methods. We performed prospective surveillance of patients with zygomycosis ( group A;) and compared them with contemporaneous patients with invasive aspergillosis (group B; n = 54) and with matched contemporaneous high-risk patients without fungal infection (group C; n = 54). We also performed molecular typing and in vitro susceptibility testing of Zygomycetes isolates.Results. Nearly all patients with zygomycosis either had leukemia (n = 14) or were allogeneic bone marrow transplant recipients (n = 13). The Zygomycetes isolates (74% of which were of the genus Rhizopus) had different molecular fingerprinting profiles, and all were VRC resistant. In multivariate analysis of groups A and C, VRC prophylaxis (odds ratio [OR], 10.37 [95% confidence interval {CI}], 2.76-38.97]; P = .001), diabetes (OR, 8.39 [95% CI, 2.04-34.35]; P = .003), and malnutrition (OR, 3.70 [95% CI, 1.03-13.27]; P = .045) were found to be independent risk factors for zygomycosis. Between patients with zygomycosis ( after excluding 6 patients with mixed mold infections) and patients with aspergillosis, VRC prophylaxis (OR, 20.30 [95% CI, 3.85-108.15]; P = .0001) and sinusitis (OR, 76.72 [95% CI, 6.48-908.15]; P = .003) were the only factors that favored the diagnosis of zygomycosis.Conclusions. Zygomycosis should be considered in immunosuppressed patients who develop sinusitis while receiving VRC prophylaxis, especially those with diabetes and malnutrition.