COVID-19-Associated Mucormycosis: Outcomes From a Tertiary Care COVID-19 Hospital

Background Mucormycosis is a type of invasive fungal infection seen in diabetics and immunocompromised individuals. During the COVID-19 pandemic, there was a rapid surge in cases of mucormycosis, leading to the origin of the term COVID-19-associated mucormycosis (CAM). Although several studies described its outcomes after treatment, very few described both short-term and long-term outcomes. This study aims to describe the immediate and long-term outcomes of the treatment of CAM at NRI General Hospital (NRIGH), a tertiary care COVID-19 hospital, to identify the factors that affect the outcomes of treatment. Methodology This is a retrospective chart review of CAM patients treated at the Department of ENT, NRIGH, from November 2020 to January 2022. Data regarding demographics, comorbidities, symptomatology, extent of disease, extent of surgery, antifungal therapy, and outcomes of treatment after one, three, six, and 12 months were collected. Cure and stable disease were defined as successful outcomes. Unstable disease or mortality due to disease was defined as unsuccessful outcomes. Univariate and multivariate longitudinal ordinal logistic regression analysis was performed to assess the association between time, clinical characteristics, and treatment-related factors with an ordinal outcome measured longitudinally (baseline, three, six, and 12 months). Results There was no statistically significant association between age, sex, duration of symptoms, laterality of disease, steroid use, and CAM outcomes. There was a statistically significant association between diabetes, hypertension, baseline extent of disease, particularly intracranial extension, and outcomes of CAM treatment (p < 0.05). Extent of surgery exhibited a time-dependent trend, with strong associations only in univariate analysis at one month (p = 0.001) and three months (p = 0.005), but weakening associations at six and 12 months (p = 0.33). Longitudinal regression model showed that antifungal therapy with amphotericin B (AMB) was related to much poorer outcomes (odds ratio = 23.2, p = 0.001). Posaconazole (PCZ) alone or AMB followed by PCZ therapy showed trends toward better outcomes, with the latter regimen showing borderline statistical significance (p = 0.05), well-supported by univariate analyses at three, six, and 12 months (all p = 0.001). The all-cause mortality rate was 14.28%. Short-term (three months) and long-term (one year) treatment success was 85.71%. Conclusions Diabetes and the extent of baseline disease adversely affect the outcomes of treatment. Surgical technique likely plays a determining role in early recovery patterns, but becomes less determinant of long-term outcomes. Drug regimens and comorbidity burden may affect outcomes, but require larger studies for confirmation.