• Eur. J. Intern. Med. · Jun 2022

    Multicenter Study

    Survival in rhino-orbito-cerebral mucormycosis: An international, multicenter ID-IRI study.

    • Yasemin Cag, Hakan Erdem, Mehmet Gunduz, Suheyla Komur, Handan Ankarali, Serap Ural, Meltem Tasbakan, Pierre Tattevin, Anil Tombak, Derya Ozturk-Engin, Ayse Sagmak Tartar, Ayse Batirel, Recep Tekin, Fazilet Duygu, Hulya Caskurlu, Behice Kurtaran, Bulent Durdu, Demet Haciseyitoglu, Jordi Rello, and ID-IRI Mucormycosis Study Group.
    • Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Kadiköy, Istanbul 34722, Turkey. Electronic address: yasemin.cag@medeniyet.edu.tr.
    • Eur. J. Intern. Med. 2022 Jun 1; 100: 56-61.

    BackgroundMucormycosis 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.MethodsThis 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.ResultsWe 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.ConclusionToday, ROCM still has high mortality rate. Improving source control, rational therpy, and preventing nosocomial infections may improve survival in this severe infection.Copyright © 2022. Published by Elsevier B.V.

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