Mucormycosis in intensive care unit: surgery is a major prognostic factor in patients with hematological malignancy

Autor: Johanna Claustre, Romaric Larcher, Thomas Jouve, Anne-Sophie Truche, Saad Nseir, Julien Cadiet, Yoann Zerbib, Alexandre Lautrette, Jean-Michel Constantin, Pierre-Emmanuel Charles, Cedric Daubin, Remi Coudroy, Jean Dellamonica, Laurent Argaud, Pierre Phelouzat, Damien Contou, Juliette Pocquet, Guillaume Voiriot, Jean-Christophe Navellou, Pierre Lavagne, Michel Durand, Muriel Cornet, Carole Schwebel, Nicolas Terzi
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Annals of Intensive Care, Vol 10, Iss 1, Pp 1-12 (2020)
Druh dokumentu: article
ISSN: 2110-5820
DOI: 10.1186/s13613-020-00673-9
Popis: Abstract Background Mucormycosis is an invasive fungal infection, with an increasing incidence especially in patients with hematological malignancies. Its prognosis is poor because of its high invasive power and its intrinsic low susceptibility to antifungal agents. We aimed to describe the epidemiology of mucormycosis in intensive care units (ICU) and evaluate the outcomes. We performed a retrospective multi-center study in 16 French ICUs between 2008 and 2017. We compared the patients who survived in ICU and the patients who did not to identify factors associated with ICU survival. Then, we focused on the subgroup of patients with hematological malignancies. Results Mucormycosis was diagnosed in 74 patients during the study period. Among them, 60 patients (81%) were immunocompromised: 41 had hematological malignancies, 9 were solid organ transplant recipients, 31 received long-term steroids, 11 had diabetes, 24 had malnutrition. Only 21 patients survived to ICU stay (28.4%) with a median survival of 22 days (Q1–Q3 = 9–106) and a survival rate at day 28 and day 90, respectively, of 35.1% and 26.4%. Survivors were significantly younger (p = 0.001), with less frequently hematological malignancies (p = 0.02), and less malnutrition (p = 0.05). Median survival in patients with hematological malignancies (n = 41) was 15 days (Q1–Q3 = 5–23.5 days). In this subgroup, curative surgery was a major factor associated with survival in multivariate analysis (odds ratio = 0.71, [0.45–0.97], p
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