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Risk factors for mortality in patients with pulmonary mucormycosis

Authors
Son, Hyo-JuSong, Joon SeonChoi, SungimJung, JiwonKim, Min JaeChong, Yong PilLee, Sang-OhChoi, Sang-HoKim, Yang SooWoo, Jun HeeKim, Sung-Han
Issue Date
Jul-2020
Publisher
Blackwell Publishing Inc.
Keywords
galactomannan; mortality; mucormycosis; neutropenia; invasive pulmonary aspergillosis; polyenes; pulmonary mucormycosis; voriconazole
Citation
Mycoses, v.63, no.7, pp 729 - 736
Pages
8
Journal Title
Mycoses
Volume
63
Number
7
Start Page
729
End Page
736
URI
https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/19486
DOI
10.1111/myc.13092
ISSN
0933-7407
1439-0507
Abstract
Background Pulmonary mucormycosis (PM) represents a serious burden in terms of morbidity and mortality in immunocompromised patients. Studies of prognostic factors in patients with PM are limited and have involved small numbers of patients. Methods Adult patients diagnosed with proven and probable PM according to the modified definitions of the EORTC/MSG 2008 in a tertiary hospital in Seoul, South Korea, between 2008 and 2019 were retrospectively enrolled. Results A total of 49 patients including 31 (63%) with proven PM and 18 (37%) with probable PM were enrolled. The 90-day mortality rate was 49% (24/49). Neutropenia, thrombocytopenia, use of voriconazole at clinical suspicion, positivity of non-sterile culture, use of steroid and treatment without surgery were more common in fatal cases than non-fatal cases. Voriconazole use at clinical suspicion for invasive mould pneumonia (OR 6.91, P = .01) and prolonged neutropenia (OR 4.86, P = .03) were independent risk factors for mortality. Voriconazole use at clinical suspicion was associated with positive galactomannan (GM) assay (OR 5.93, P = .02) and history of invasive pulmonary aspergillosis (OR, 6.88, P = .05). Conclusion About half of the patients with PM died within 90 days of diagnosis, and fatal outcomes were common in patients with prolonged neutropenia and empirical voriconazole use. Caution is needed in using voriconazole even in patients with positive GM results and prior histories of invasive pulmonary aspergillosis in whom PM cannot be ruled out by differential diagnosis.
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