Stability in the cumulative incidence, severity and mortality of 101 cases of invasive mucormycosis in high-risk patients from 1995 to 2011: a comparison of eras immediately before and after the availability of voriconazole and echinocandin-amphotericin c

Autor:	Donna Jane Hata, Nancy L. Wengenack, Mark R. Litzow, Mark P. Wilhelm, Nathan W. Cummins, Amy J. Wendel, Eric M. Poeschla, Lisa Brumble, Brian D. Lahr, Holenarasipur R. Vikram, Ann E. McCullough, Maheen Z. Abidi, Muhammad R. Sohail, Randall C. Walker, Harshal Shah, Louis Letendre, Shimon Kusne
Rok vydání:	2014
Předmět:	Adult Male medicine.medical_specialty Antifungal Agents Echinocandin Combination therapy Dermatology History 21st Century Gastroenterology Article Echinocandins Young Adult Amphotericin B Internal medicine medicine Humans Mucormycosis Cumulative incidence Aged Voriconazole business.industry Incidence (epidemiology) Fungi General Medicine Middle Aged medicine.disease United States Surgery Transplantation Infectious Diseases Drug Therapy Combination Female business medicine.drug
Zdroj:	Mycoses. 57:687-698
ISSN:	0933-7407
DOI:	10.1111/myc.12222
Popis:	Summary As invasive mucormycosis (IM) numbers rise, clinicians suspect prior voriconazole worsens IM incidence and severity, and believe combination anti-fungal therapy improves IM survival. To compare the cumulative incidence (CI), severity and mortality of IM in eras immediately before and after the commercial availability of voriconazole all IM cases from 1995 to 2011 were analysed across four risk-groups (hematologic/oncologic malignancy (H/O), stem cell transplantation (SCT), solid organ transplantation (SOT) and other), and two eras, E1 (1995–2003) and E2, (2004–2011). Of 101 IM cases, (79 proven, 22 probable): 30 were in E1 (3.3/year) and 71 in E2 (8.9/year). Between eras, the proportion with H/O or SCT rose from 47% to 73%, while ‘other’ dropped from 33% to 11% (P = 0.036). Between eras, the CI of IM did not significantly increase in SCT (P = 0.27) or SOT (P = 0.30), and patterns of anatomic location (P = 0.122) and surgical debridement (P = 0.200) were similar. Significantly more patients received amphotericin-echinocandin combination therapy in E2 (31% vs. 5%, P = 0.01); however, 90-day survival did not improve (54% vs. 59%, P = 0.67). Since 2003, the rise of IM reflects increasing numbers at risk, not prior use of voriconazole. Frequent combination of anti-fungal therapy has not improved survival.
Databáze:	OpenAIRE
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