Review of Treatment Regimens for Mucormycosis in a Las Vegas County Hospital Between 2013 and 2017

BACKGROUND: Mucormycosis (MC) is a group of invasive fungal infections with a mortality rate approaching 100% in disseminated disease. The incidence of MC is low, with one study estimating 500 cases/year in the United States, making optimal treatment difficult to identify. Liposomal amphotericin B (L-ampho), along with aggressive surgical intervention, is the first-line treatment for MC. Isavuconazole (ISA) and posaconazole (POSA) are newer azoles used as salvage therapy in patients not improving with L-ampho. Limited data are available about the use of L-ampho in combination with ISA or POSA as an initial treatment regimen, but aggressive treatment empirically may increase favorable outcomes. METHODS: We performed a retrospective review of patients diagnosed with MC from 2013 to2017 at University Medical Center of Southern Nevada in Las Vegas, Nevada. Data collected included patient demographics, comorbidities, and predisposing risk factors as well as treatment regimens. Patients were evaluated for outcome after treatment therapy with monotherapy (L-ampho, POSA or ISA) or combination therapy (L-ampho with ISA). RESULTS: From 2013 to 2017, seven cases of MC were identified – five rhinocerebral (RC), one cutaneous (CT), and 1onepulmonary (PM). The most common risk factor was uncontrolled diabetes (5/7), followed by HIV (2/7) and non-Hodgkin lymphoma (1/7). Fifty-seven percent of patients received monotherapy and 43% received combination therapy (L-ampho/ISA). All the patients receiving combination therapy had RC. Seventy-one percent of patients survived to discharge regardless of treatment regimen. One hundred percent of combination therapy patients survived to discharge, whereas 50% of monotherapy patients survived to discharge. The two mortalities were patients with PM and CT MC. CONCLUSION: MC is a rare infection with high mortality. For this reason, we are using ISA in combination with L-ampho as initial treatment to improve clinical outcomes. With our limited experience, combination therapy showed better rates of survival to discharge, without increasing adverse events. Our data suggest the use of combination therapy may improve outcomes in MC, but a larger sample of patients treated with initial combination therapy is required to strengthen conclusions about patient outcomes. DISCLOSURES: All authors: No reported disclosures.