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Mucormycosis in intensive care unit: surgery is a major prognostic factor in patients with hematological malignancy
BACKGROUND: Mucormycosis 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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280386/ https://www.ncbi.nlm.nih.gov/pubmed/32514787 http://dx.doi.org/10.1186/s13613-020-00673-9 |
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author | Claustre, Johanna Larcher, Romaric Jouve, Thomas Truche, Anne-Sophie Nseir, Saad Cadiet, Julien Zerbib, Yoann Lautrette, Alexandre Constantin, Jean-Michel Charles, Pierre-Emmanuel Daubin, Cedric Coudroy, Remi Dellamonica, Jean Argaud, Laurent Phelouzat, Pierre Contou, Damien Pocquet, Juliette Voiriot, Guillaume Navellou, Jean-Christophe Lavagne, Pierre Durand, Michel Cornet, Muriel Schwebel, Carole Terzi, Nicolas |
author_facet | Claustre, Johanna Larcher, Romaric Jouve, Thomas Truche, Anne-Sophie Nseir, Saad Cadiet, Julien Zerbib, Yoann Lautrette, Alexandre Constantin, Jean-Michel Charles, Pierre-Emmanuel Daubin, Cedric Coudroy, Remi Dellamonica, Jean Argaud, Laurent Phelouzat, Pierre Contou, Damien Pocquet, Juliette Voiriot, Guillaume Navellou, Jean-Christophe Lavagne, Pierre Durand, Michel Cornet, Muriel Schwebel, Carole Terzi, Nicolas |
author_sort | Claustre, Johanna |
collection | PubMed |
description | BACKGROUND: Mucormycosis 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. RESULTS: Mucormycosis 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). CONCLUSION: Overall 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. |
format | Online Article Text |
id | pubmed-7280386 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-72803862020-06-16 Mucormycosis in intensive care unit: surgery is a major prognostic factor in patients with hematological malignancy Claustre, Johanna Larcher, Romaric Jouve, Thomas Truche, Anne-Sophie Nseir, Saad Cadiet, Julien Zerbib, Yoann Lautrette, Alexandre Constantin, Jean-Michel Charles, Pierre-Emmanuel Daubin, Cedric Coudroy, Remi Dellamonica, Jean Argaud, Laurent Phelouzat, Pierre Contou, Damien Pocquet, Juliette Voiriot, Guillaume Navellou, Jean-Christophe Lavagne, Pierre Durand, Michel Cornet, Muriel Schwebel, Carole Terzi, Nicolas Ann Intensive Care Research BACKGROUND: Mucormycosis 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. RESULTS: Mucormycosis 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). CONCLUSION: Overall 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. Springer International Publishing 2020-06-08 /pmc/articles/PMC7280386/ /pubmed/32514787 http://dx.doi.org/10.1186/s13613-020-00673-9 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Research Claustre, Johanna Larcher, Romaric Jouve, Thomas Truche, Anne-Sophie Nseir, Saad Cadiet, Julien Zerbib, Yoann Lautrette, Alexandre Constantin, Jean-Michel Charles, Pierre-Emmanuel Daubin, Cedric Coudroy, Remi Dellamonica, Jean Argaud, Laurent Phelouzat, Pierre Contou, Damien Pocquet, Juliette Voiriot, Guillaume Navellou, Jean-Christophe Lavagne, Pierre Durand, Michel Cornet, Muriel Schwebel, Carole Terzi, Nicolas Mucormycosis in intensive care unit: surgery is a major prognostic factor in patients with hematological malignancy |
title | Mucormycosis in intensive care unit: surgery is a major prognostic factor in patients with hematological malignancy |
title_full | Mucormycosis in intensive care unit: surgery is a major prognostic factor in patients with hematological malignancy |
title_fullStr | Mucormycosis in intensive care unit: surgery is a major prognostic factor in patients with hematological malignancy |
title_full_unstemmed | Mucormycosis in intensive care unit: surgery is a major prognostic factor in patients with hematological malignancy |
title_short | Mucormycosis in intensive care unit: surgery is a major prognostic factor in patients with hematological malignancy |
title_sort | mucormycosis in intensive care unit: surgery is a major prognostic factor in patients with hematological malignancy |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280386/ https://www.ncbi.nlm.nih.gov/pubmed/32514787 http://dx.doi.org/10.1186/s13613-020-00673-9 |
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