Parasitology-Mycology, University Hospital of Besançon, Besançon, France.
Chrono-Environment UMR CNRS- 6249, University of Franche-Comté, Besançon, France.
Med Mycol. 2024 Mar 28;62(4). doi: 10.1093/mmy/myae030.
Our objective was to determine whether the twice-weekly screening of high-risk hematology patients by Mucorales qPCR on serum affects the prognosis of mucormycosis. Results from all serum Mucorales qPCR tests performed on patients from the hematology unit from January 2017 to December 2022 were analyzed. Patients with positive results were classified as having proven, probable or 'PCR-only' mucormycosis. One-month mortality for the local cohort was compared with that of a national cohort of cases of mucormycosis collected by the French surveillance network for invasive fungal disease ('Réseau de surveillances des infections fongiques invasives en France' (RESSIF)) from 2012 to 2018. From 2017 to 2022, 7825 serum Mucorales qPCR tests were performed for patients from the hematology unit; 107 patients with at least one positive Mucorales qPCR (164 positive samples) were identified. Sixty patients (70 positive samples, median Cq = 40) had no radiological criteria for mucormycosis and were considered not to have invasive fungal disease (70/7825, 0.9% false positives). It was not possible to classify disease status for six patients (12 positive samples, median Cq = 38). Forty-one patients (82 positive samples, median Cq = 35) had a final diagnosis of mucormycosis. In comparison with the RESSIF cohort, the local cohort was independently associated with a 48% lower one-month all-cause mortality rate (age-, sex-, and primary disease-adjusted hazard ratio = 0.52; 95% confidence interval: 0.29-0.94; P 0.03). Proactive screening for invasive mold diseases in high-risk hematology patients, including twice-weekly Mucorales qPCR on serum, was associated with mucormycosis higher survival.
我们的目的是确定高风险血液病患者每周两次通过血清进行毛霉 qPCR 筛查是否会影响毛霉病的预后。分析了 2017 年 1 月至 2022 年 12 月血液科患者所有血清毛霉 qPCR 检测的结果。将阳性结果患者分为确诊、可能或“仅 PCR”毛霉病。比较了本地队列的一个月死亡率与法国侵袭性真菌病监测网络（Réseau de surveillances des infections fongiques invasives en France (RESSIF)）收集的 2012 年至 2018 年毛霉病病例的全国性队列的死亡率。2017 年至 2022 年，对血液科患者进行了 7825 次血清毛霉 qPCR 检测；确定了 107 名至少有一次阳性毛霉 qPCR（164 个阳性样本）的患者。60 名患者（70 个阳性样本，中位 Cq=40）无毛霉病的放射学标准，不考虑侵袭性真菌病（7825 例患者中有 70/7825 例，假阳性率为 0.9%）。无法对 6 名患者（12 个阳性样本，中位 Cq=38）进行疾病状态分类。41 名患者（82 个阳性样本，中位 Cq=35）最终诊断为毛霉病。与 RESSIF 队列相比，本地队列与一个月全因死亡率降低 48%独立相关（年龄、性别和主要疾病调整后的危险比=0.52；95%置信区间：0.29-0.94；P=0.03）。对高危血液病患者进行侵袭性霉菌病的主动筛查，包括每周两次的血清毛霉 qPCR，与毛霉病的高生存率相关。
