A multicentre observational study on the epidemiology, risk factors, management and outcomes of mucormycosis in India
A multicentre observational study on the epidemiology, risk factors, management and outcomes of mucormycosis in India
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DOI：
10.1016/j.cmi.2019.11.021
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发表时间：
2020-07-01
影响因子：
14.2
通讯作者：
Chakrabarti, A.
中科院分区：
文献类型：
--
作者：
Patel, A.;Kaur, H.;Chakrabarti, A.
目的：描述毛霉菌病的流行病学、治疗和预后，并评估与死亡率相关的危险因素。方法：我们进行了一项前瞻性观察性研究，涉及来自印度12个中心的连续确诊毛霉菌病的个体。记录人口统计学特征、微生物学、诱发因素、管理和90天死亡率;分析死亡率的危险因素。结果：共纳入465例患者。鼻眶毛霉菌病是最常见的（315/465，67.7%）表现，其次是肺部（62/465，13.3%）、皮肤（49/465，10.5%）和其他。诱发因素包括糖尿病（342/465，73.5%）、恶性肿瘤（42/465，9.0%）、移植（36/ 465，7.7%）和其他。根霉属（231/290，79.7%）是最常见的，其次是多变拟青霉（23/290，7.9%）和几种罕见的毛霉目。62.2%（289/465）的参与者进行了手术治疗。两性霉素B是81.9%（381/465）的主要治疗方法，53例（11.4%）患者使用了泊沙康唑作为联合治疗。7.6%（30/394）的患者抗真菌治疗不当。90天死亡率为52%（242/465）。在多变量分析中，播散性和鼻-眼眶（伴有大脑扩展）毛霉菌病、症状持续时间较短、抗真菌治疗持续时间较短和使用阿替霉素B脱氧胆酸盐（与脂质体相比）治疗是死亡率的独立危险因素。内科和外科联合治疗与更好的生存率相关。结论：糖尿病是所有毛霉菌病的主要易感因素。手术和药物联合治疗可获得更好的结局。毛霉菌病的管理中出现了几个空白。本研究中鉴定的罕见毛霉目菌需要进一步评价。A. Patel，临床微生物感染2020;26：944.e9 - 944.e15？2019年欧洲临床微生物学和传染病学会。由爱思唯尔有限公司出版。保留所有权利。
Objectives: To describe the epidemiology, management and outcome of individuals with mucormycosis; and to evaluate the risk factors associated with mortality. Methods: We conducted a prospective observational study involving consecutive individuals with proven mucormycosis across 12 centres from India. The demographic pro file, microbiology, predisposing factors, management and 90 -day mortality were recorded; risk factors for mortality were analysed. Results: We included 465 patients. Rhino -orbital mucormycosis was the most common (315/465, 67.7%) presentation followed by pulmonary (62/465, 13.3%), cutaneous (49/465, 10.5%), and others. The pre- disposing factors included diabetes mellitus (342/465, 73.5%), malignancy (42/465, 9.0%), transplant (36/ 465, 7.7%), and others. Rhizopus species (231/290, 79.7%) were the most common followed by Apophy- somyces variabilis (23/290, 7.9%), and several rare Mucorales . Surgical treatment was performed in 62.2% (289/465) of the participants. Amphotericin B was the primary therapy in 81.9% (381/465), and pos- aconazole was used as combination therapy in 53 (11.4%) individuals. Antifungal therapy was inappro- priate in 7.6% (30/394) of the individuals. The 90 -day mortality rate was 52% (242/465). On multivariate analysis, disseminated and rhino -orbital (with cerebral extension) mucormycosis, shorter duration of symptoms, shorter duration of antifungal therapy, and treatment with amphotericin B deoxycholate (versus liposomal) were independent risk factors of mortality. A combined medical and surgical man- agement was associated with a better survival. Conclusions: Diabetes mellitus was the dominant predisposing factor in all forms of mucormycosis. Combined surgical and medical management was associated with better outcomes. Several gaps surfaced in the management of mucormycosis. The rarer Mucorales identi fied in the study warrant further eval- uation. A. Patel, Clin Microbiol Infect 2020;26:944.e9 - 944.e15 ? 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.