978. Disease Associations and Outcomes in Hospitalized Patients with Non-Cutaneous Mucormycosis: Data from the National Inpatient Sample

Abstract

Abstract Background Data regarding comorbidities and hospital outcomes among patients with non-cutaneous mucormycosis is primarily derived from case reports and single institution series. This study was undertaken to define the prevalence of this condition among adult inpatients in the United States and to measure the frequency of comorbid illnesses and outcomes of inpatients with mucormycosis. Methods The 2016 National Inpatient Sample was used to identify a cohort of patients with a hospital diagnosis of non-cutaneous mucormycosis. Patients with mucormycosis and comorbid medical illnesses were identified by ICD-10 codes. The impact of disease site and comorbid illness on inpatient mortality was measured. Results A cohort of 95 adults with non-cutaneous mucormycosis was identified and included patients with pulmonary (n=53), rhinocerbral (n=25), disseminated (n=17), and gastrointestinal (n=4) mucormycosis. The prevalence of non-cutaneous mucormycosis was 15.7 cases per million admissions. Frequently associated medical conditions included diabetes mellitus (45.3%), hematologic malignancy (34.7%), hematopoietic stem cell transplant (6.3%), long term use of systemic steroids (6.3%), myelodysplastic syndrome (6.3%), solid organ transplant (5.3%), non-hematologic malignancy (4.2%), and iron overload disorders (2.1%). The median age of adults hospitalized with non-cutaneous mucormycosis was 53.2 years (range 18-83); patients were predominantly male (78.9%) and Caucasian (51.8%). The median length of stay for this cohort was 20 days (range 1-190) with a median total hospital cost of &323, 470 (range &2,401-&1,958,259) and an in-hospital mortality rate of 20%. The inpatient mortality rate was increased with underlying myelodysplastic syndrome (p=0.003) but not by other associated medical conditions or by site of disease. Conclusion Non-cutaneous mucormycosis is associated with a high in-hospital mortality rate and should be considered in patients with suggestive clinical presentations and underlying diabetes or conditions associated immunosuppression. Prompt recognition and tissue confirmation of this diagnosis leading to early surgical intervention and systemic antifungal therapy may improve outcomes. Disclosures All Authors: No reported disclosures