Abstract
BackgroundMucormycosis is an invasive fungal infection, with an increasing incidence especially in patients with hematological malignancies. Its prognosis is poor because of its high invasive power and its intrinsic low susceptibility to antifungal agents. We aimed to describe the epidemiology of mucormycosis in intensive care units (ICU) and evaluate the outcomes. We performed a retrospective multi-center study in 16 French ICUs between 2008 and 2017. We compared the patients who survived in ICU and the patients who did not to identify factors associated with ICU survival. Then, we focused on the subgroup of patients with hematological malignancies.ResultsMucormycosis was diagnosed in 74 patients during the study period. Among them, 60 patients (81%) were immunocompromised: 41 had hematological malignancies, 9 were solid organ transplant recipients, 31 received long-term steroids, 11 had diabetes, 24 had malnutrition. Only 21 patients survived to ICU stay (28.4%) with a median survival of 22 days (Q1–Q3 = 9–106) and a survival rate at day 28 and day 90, respectively, of 35.1% and 26.4%. Survivors were significantly younger (p = 0.001), with less frequently hematological malignancies (p = 0.02), and less malnutrition (p = 0.05). Median survival in patients with hematological malignancies (n = 41) was 15 days (Q1–Q3 = 5–23.5 days). In this subgroup, curative surgery was a major factor associated with survival in multivariate analysis (odds ratio = 0.71, [0.45–0.97], p < 0.001).ConclusionOverall prognosis of mucormycosis in ICU remains poor, especially in patients with hematological malignancies. In this subgroup of patients, a therapeutic strategy including curative surgery was the main factor associated with survival.
Highlights
Mucormycosis is an invasive fungal infection, with an increasing incidence especially in patients with hematological malignancies
We aimed to describe the epidemiology of mucormycosis in French intensive care units (ICU) and to evaluate the outcomes, to highlight the most important determinants of the therapeutic strategy, especially in patients with hematological malignancies
Demographic characteristics During the study period, 74 patients with mucormycosis were included from 16 French ICU
Summary
Mucormycosis is an invasive fungal infection, with an increasing incidence especially in patients with hematological malignancies. Claustre et al Ann. Intensive Care (2020) 10:74 innate immunity: allogenic hematopoietic stem cell transplantation (HSCT), chemotherapy, diabetes, longterm steroids or immunosuppressive treatments, solid organ transplantation (SOT) [2,3,4]. The number of immunocompromised patients is increasing [2, 9]. In this population, many patients accumulate different risk factors like diabetes or malnutrition [2]. The development of new therapeutic strategies, especially the larger use of antifungal drugs that are ineffective against mucorales, such as voriconazole, can constitute a new risk factor of mucormycosis [10, 11]
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