法国毛霉病的流行病学及预后因素（2012 - 2022年）：一项纳入前瞻性监测项目的横断面研究
Epidemiology and prognostic factors of mucormycosis in France (2012-2022): a cross-sectional study nested in a prospective surveillance programme.
作者信息
Gouzien Laura, Che Didier, Cassaing Sophie, Lortholary Olivier, Letscher-Bru Valérie, Paccoud Olivier, Obadia Thomas, Morio Florent, Moniot Maxime, Cateau Estelle, Bougnoux Marie Elisabeth, Chouaki Taieb, Hasseine Lilia, Desoubeaux Guillaume, Gautier Cecile, Mahinc-Martin Caroline, Huguenin Antoine, Bonhomme Julie, Sitbon Karine, Durand Julien, Alanio Alexandre, Millon Laurence, Garcia-Hermoso Dea, Lanternier Fanny
机构信息
Institut Pasteur, Paris Cité University, National Reference Center for Invasives Mycoses and Antifungals, Mycology Department, Paris, France.
Intensive Care Unit, Centre Hospitalier de Versailles, Le Chesnay, France.
出版信息
Lancet Reg Health Eur. 2024 Aug 7;45:101010. doi: 10.1016/j.lanepe.2024.101010. eCollection 2024 Oct.
BACKGROUND
Mucormycosis is a deadly invasive fungal infection recently included in the WHO priority pathogen list. Here we sought to describe epidemiological trends of mucormycosis in France, and to evaluate factors associated with mortality.
METHODS
From 2012 to 2022, we implemented a nationwide prospective surveillance programme for mucormycosis in France, focusing on epidemiology, species, seasonal variations. Factors associated with 3-month mortality were studied by univariable and multivariable logistic regression.
FINDINGS
Among 550 cases of mucormycosis, the main underlying conditions were haematological malignancy (HM, 65.1%, 358/550), trauma (8%, 44/550), diabetes (7.5%, 41/550) and solid-organ transplants (6.5%, 36/550). Site of infection was pulmonary in 52.4% (288/550), rhinocerebral in 14.5% (80/550), and cutaneo-articular in 17.1% (94/550). Main species identified were (21%, 67/316), (13.6%, 43/316), and (13.3%, 42/316 each), (12%, 38/316), and (10.8%, 34/316). We found associations between underlying condition, site of infection, and infecting species, including a previously undescribed triad of trauma, cutaneo-articular localisations, and /. Diagnostic contribution of Polymerase Chain Reaction (PCR) increased from 16% (4/25) in 2012 to 91% (61/67) in 2022, with more than 50% of diagnoses relying solely on PCR in 2022. We also found seasonal variations with relatively more cases in autumn. Ninety-day mortality was 55.8% (276/495). Independent prognostic factors were age, diagnosis in Intensive Care Unit (ICU), and HM while diagnosis after 2015 (i.e. large implementation of PCR) and surgery were associated with reduced mortality.
INTERPRETATION
This study reveals major mucormycosis epidemiological changes in France, with a large predominance of HM patients, and a parallel between PCR multicentre implementation and improved prognosis. We also evidence new associations between species, localisations and risk factors, as well as seasonal variations.
FUNDING
Recurrent financial support from Santé Publique France and Institut Pasteur.
背景
毛霉病是一种致命的侵袭性真菌感染，最近被列入世界卫生组织重点病原体清单。在此，我们试图描述法国毛霉病的流行病学趋势，并评估与死亡率相关的因素。
方法
2012年至2022年，我们在法国实施了一项全国性的毛霉病前瞻性监测计划，重点关注流行病学、菌种、季节变化。通过单变量和多变量逻辑回归研究与3个月死亡率相关的因素。
研究结果
在550例毛霉病病例中，主要基础疾病为血液系统恶性肿瘤（HM，65.1%，358/550）、创伤（8%，44/550）、糖尿病（7.5%，41/550）和实体器官移植（6.5%，36/550）。感染部位为肺部的占52.4%（288/550），鼻脑部位的占14.5%（80/550），皮肤关节部位的占17.1%（94/550）。鉴定出的主要菌种为 （21%，67/316）、 （13.6%，43/316）、 以及 （各占13.3%，42/316）、 （12%，38/316）和 （10.8%，34/316）。我们发现基础疾病、感染部位和感染菌种之间存在关联，包括一种此前未描述过的创伤、皮肤关节定位和 / 的三联征。聚合酶链反应（PCR）的诊断贡献从2012年的16%（4/25）增至2022年的91%（61/67），2022年超过50%的诊断仅依靠PCR。我们还发现了季节性变化，秋季病例相对较多。90天死亡率为55.8%（276/495）。独立的预后因素为年龄、在重症监护病房（ICU）诊断、HM，而2015年后（即大规模实施PCR）的诊断和手术与死亡率降低相关。
解读
本研究揭示了法国毛霉病主要的流行病学变化，HM患者占主导地位，PCR在多中心的实施与预后改善并行。我们还证明了菌种、定位和危险因素之间的新关联以及季节性变化。
资金来源
法国公共卫生署和巴斯德研究所的经常性财政支持。
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