Cag Yasemin, Erdem Hakan, Gunduz Mehmet, Komur Suheyla, Ankarali Handan, Ural Serap, Tasbakan Meltem, Tattevin Pierre, Tombak Anil, Ozturk-Engin Derya, Tartar Ayse Sagmak, Batirel Ayse, Tekin Recep, Duygu Fazilet, Caskurlu Hulya, Kurtaran Behice, Durdu Bulent, Haciseyitoglu Demet, Rello Jordi
Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Kadiköy, Istanbul 34722, Turkey.
Department of Infectious Diseases, Bahrain Oncology Center, King Hamad University Hospital, Busaiteen, Bahrain.
Eur J Intern Med. 2022 Jun;100:56-61. doi: 10.1016/j.ejim.2022.03.008. Epub 2022 Mar 15.
Mucormycosis is an emerging aggressive mold infection. This study aimed to assess the outcome of hospitalized adults with rhino-orbito-cerebral mucormycosis (ROCM). The secondary objective was to identify prognostic factors in this setting.
This study was an international, retrospective, multicenter study. Patients' data were collected from 29 referral centers in 6 countries. All qualified as "proven cases" according to the EORTC/MSGERC criteria.
We included 74 consecutive adult patients hospitalized with ROCM. Rhino-orbito-cerebral type infection was the most common presentation (n = 43; 58.1%) followed by rhino-orbital type (n = 31; 41.9%). Twenty (27%) had acquired nosocomial bacterial infections. A total of 59 (79.7%) patients (16 in combination) received appropriate antifungal treatment with high-doses of liposomal amphotericin B. Fifty-six patients (75.7%) underwent curative surgery. Thirty-five (47.3%) required intensive care unit admission (27; 36.5% under mechanical ventilation). Hospital survival was 56.8%, being reduced to 7.4% in patients with invasive mechanical ventilation. A multivariate binary backward logistic regression model identified confusion at admission (OR 11.48), overlapping hospital-acquired infection (OR 10.27), use of antifungal treatment before diagnosis (OR 10.20), no surgical debridement (OR 5.92), and the absence of prior sinusitis (OR 6.32) were independently associated with increased risk for death.
Today, ROCM still has high mortality rate. Improving source control, rational therpy, and preventing nosocomial infections may improve survival in this severe infection.
毛霉病是一种新出现的侵袭性霉菌感染。本研究旨在评估住院的成人鼻眶脑型毛霉病（ROCM）患者的预后。次要目标是确定此情况下的预后因素。
本研究是一项国际性、回顾性、多中心研究。患者数据收集自6个国家的29个转诊中心。所有患者均根据欧洲癌症研究与治疗组织/毛霉病研究合作组（EORTC/MSGERC）标准被判定为“确诊病例”。
我们纳入了74例连续住院的ROCM成年患者。鼻眶脑型感染是最常见的表现形式（n = 43；58.1%），其次是鼻眶型（n = 31；41.9%）。20例（27%）患者发生了医院获得性细菌感染。共有59例（79.7%）患者（其中16例联合用药）接受了高剂量脂质体两性霉素B的适当抗真菌治疗。56例（75.7%）患者接受了根治性手术。35例（47.3%）患者需要入住重症监护病房（27例；36.5%接受机械通气）。住院生存率为56.8%，在接受有创机械通气的患者中降至7.4%。多因素二元向后逻辑回归模型确定，入院时意识障碍（比值比[OR] 11.48）、重叠的医院获得性感染（OR 10.27）、诊断前使用抗真菌治疗（OR 10.20）、未进行手术清创（OR 5.92）以及无既往鼻窦炎（OR 6.32）与死亡风险增加独立相关。
如今，ROCM的死亡率仍然很高。改善源头控制、合理治疗以及预防医院感染可能会提高这种严重感染的生存率。
