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Survival in rhino-orbito-cerebral mucormycosis: An international, multicenter ID-IRI study
Yasemin Cag1, Hakan Erdem2, Mehmet Gunduz3
1Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Kadiköy, Istanbul 34722, Turkey.
Background:
Mucormycosis 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.
Methods:
This 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.
Results:
We 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.
Conclusion:
Today, ROCM still has high mortality rate. Improving source control, rational therpy, and preventing nosocomial infections may improve survival in this severe infection.
Insights
Rhino-orbito-cerebral mucormycosis (ROCM) has a high mortality rate. Factors like confusion, hospital-acquired infections, and lack of surgery increase death risk in ROCM patients.
Area of Science:
- Infectious Diseases
- Mycology
- Critical Care Medicine
Background:
- Mucormycosis is an aggressive emerging mold infection.
- Rhino-orbito-cerebral mucormycosis (ROCM) is a severe clinical manifestation.
- High mortality rates underscore the need for better understanding and management.
Purpose of the Study:
- To assess the outcomes of hospitalized adult patients diagnosed with ROCM.
- To identify key prognostic factors associated with mortality in ROCM cases.
Main Methods:
- International, retrospective, multicenter study involving 29 referral centers across 6 countries.
- Inclusion of 74 adult patients with "proven cases" of ROCM based on EORTC/MSGERC criteria.
- Data collection and analysis using multivariate logistic regression to identify risk factors.
Main Results:
- The study included 74 adult patients with ROCM, with the rhino-orbito-cerebral type being most common (58.1%).
- Hospital survival was 56.8%, significantly lower (7.4%) in patients requiring invasive mechanical ventilation.
- Independent predictors of increased mortality included confusion at admission, hospital-acquired infections, delayed antifungal treatment, absence of surgical debridement, and lack of prior sinusitis.
Conclusions:
- ROCM continues to present a significant mortality challenge.
- Improving source control, optimizing antifungal therapy, and preventing nosocomial infections are crucial for enhancing patient survival.
- Prognostic factors identified can guide clinical management and risk stratification.
