Emerg Infect Dis. 2023 Jan;29(1):8-19. doi: 10.3201/eid2901.220926.
We performed a case–control study across 25 hospitals in India for the period of January–June 2021 to evaluate the reasons for an COVID-19–associated mucormycosis (CAM) outbreak. We investigated whether COVID-19 treatment practices (glucocorticoids, zinc, tocilizumab, and others) were associated with CAM. We included 1,733 cases of CAM and 3,911 age-matched COVID-19 controls. We found cumulative glucocorticoid dose (odds ratio [OR] 1.006, 95% CI 1.004–1.007) and zinc supplementation (OR 2.76, 95% CI 2.24–3.40), along with elevated C-reactive protein (OR 1.004, 95% CI 1.002–1.006), host factors (renal transplantation [OR 7.58, 95% CI 3.31–17.40], diabetes mellitus [OR 6.72, 95% CI 5.45–8.28], diabetic ketoacidosis during COVID-19 [OR 4.41, 95% CI 2.03–9.60]), and rural residence (OR 2.88, 95% CI 2.12–3.79), significantly associated with CAM. Mortality rate at 12 weeks was 32.2% (473/1,471). We emphasize the judicious use of COVID-19 therapies and optimal glycemic control to prevent CAM.
我们在印度的 25 家医院进行了一项病例对照研究，研究时间为 2021 年 1 月至 6 月，旨在评估 COVID-19 相关毛霉菌病（CAM）爆发的原因。我们调查了 COVID-19 治疗方法（皮质类固醇、锌、托珠单抗等）是否与 CAM 相关。我们纳入了 1733 例 CAM 病例和 3911 例年龄匹配的 COVID-19 对照组。我们发现累积皮质类固醇剂量（比值比 [OR] 1.006，95%置信区间 [CI] 1.004-1.007）和锌补充剂（OR 2.76，95% CI 2.24-3.40），以及 C 反应蛋白升高（OR 1.004，95% CI 1.002-1.006）、宿主因素（肾移植 [OR 7.58，95% CI 3.31-17.40]、糖尿病 [OR 6.72，95% CI 5.45-8.28]、COVID-19 期间的糖尿病酮症酸中毒 [OR 4.41，95% CI 2.03-9.60]）和农村居住（OR 2.88，95% CI 2.12-3.79）与 CAM 显著相关。12 周时的死亡率为 32.2%（473/1471）。我们强调应谨慎使用 COVID-19 疗法和优化血糖控制，以预防 CAM。
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