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

Authors
  • Claustre, Johanna1
  • Larcher, Romaric2
  • Jouve, Thomas3, 4
  • Truche, Anne-Sophie3, 5
  • Nseir, Saad6
  • Cadiet, Julien7
  • Zerbib, Yoann8
  • Lautrette, Alexandre9
  • Constantin, Jean-Michel9
  • Charles, Pierre-Emmanuel10
  • Daubin, Cedric11
  • Coudroy, Remi12
  • Dellamonica, Jean13
  • Argaud, Laurent14
  • Phelouzat, Pierre15
  • Contou, Damien16
  • Pocquet, Juliette17
  • Voiriot, Guillaume18
  • Navellou, Jean-Christophe19
  • Lavagne, Pierre20
  • And 4 more
  • 1 Service de Pneumologie, CH Annecy Genevois, 1 Avenue de l’hôpital, Epagny Metz-Tessy, 74370, France , Epagny Metz-Tessy (France)
  • 2 Médecine Intensive Réanimation, CHU Montpellier, Montpellier, France , Montpellier (France)
  • 3 Université Grenoble Alpes, Grenoble, France , Grenoble (France)
  • 4 CHU Grenoble Alpes, Grenoble, France , Grenoble (France)
  • 5 Médecine Intensive Réanimation, CHU Grenoble Alpes, Grenoble, France , Grenoble (France)
  • 6 Réanimation Médicale, CHU Lille, Lille, France , Lille (France)
  • 7 Service de médecine intensive Réanimation, CHU Nantes, Nantes, France , Nantes (France)
  • 8 Réanimation Chirurgicale, Amiens, France , Amiens (France)
  • 9 Réanimation CHU Clermont-Ferrand, Clermont-Ferrand, France , Clermont-Ferrand (France)
  • 10 Médecine intensive Réanimation, CHU Dijon, Dijon, France , Dijon (France)
  • 11 Réanimation médicale, CHU Caen, Caen, France , Caen (France)
  • 12 Réanimation médicale, CHU Poitiers, Poitiers, France , Poitiers (France)
  • 13 Médecine Intensive Réanimation, CHU Nice, Université Côte d’Azur, Nice, France , Nice (France)
  • 14 Réanimation Médicale, CHU Lyon, Lyon, France , Lyon (France)
  • 15 Réanimation Médicale, CHU Rennes, Rennes, France , Rennes (France)
  • 16 Réanimation polyvalente, CH Argenteuil, Argenteuil, France , Argenteuil (France)
  • 17 Médecine intensive Réanimation, CHU Tours, Tours, France , Tours (France)
  • 18 Réanimation médico-chirurgicale, CHU Tenon, Paris, France , Paris (France)
  • 19 Réanimation médicale, CHU Besançon, Besançon, France , Besançon (France)
  • 20 Réanimation Polyvalente Chirurgicale, CHU Grenoble Alpes, Grenoble, France , Grenoble (France)
  • 21 Réanimation Cardio-vasculaire et Thoracique, CHU Grenoble Alpes, Grenoble, France , Grenoble (France)
Type
Published Article
Journal
Annals of Intensive Care
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Jun 08, 2020
Volume
10
Issue
1
Identifiers
DOI: 10.1186/s13613-020-00673-9
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundMucormycosis 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.ResultsMucormycosis 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 < 0.001).ConclusionOverall prognosis of mucormycosis in ICU remains poor, especially in patients with hematological malignancies. In this subgroup of patients, a therapeutic strategy including curative surgery was the main factor associated with survival.

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