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Introduction of a Comprehensive Diagnostic and Interdisciplinary Management Approach in Haematological Patients with Mucormycosis: A Pre and Post-Intervention Analysis

Mucormycosis is a life threatening infection in patients with haematological disease. We introduced a Mucorales-PCR and an aggressive, multidisciplinary management approach for mucormycosis during 2016–2017 and evaluated patient outcomes in 13 patients diagnosed and treated in 2012–2019. Management...

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Autores principales: Risum, Malene, Helweg-Larsen, Jannik, Petersen, Søren Lykke, Kampmann, Peter, Overgaard, Ulrik Malthe, El Fassi, Daniel, Nielsen, Ove Juul, Brabrand, Mette, Rubek, Niclas, Munksgaard, Lars, Severinsen, Marianne Tang, Nielsen, Bendt, Gertsen, Jan Berg, Gylfe, Åsa, Hjort, Ulla, Vourtsi, Angeliki, Hare, Rasmus Krøger, Arendrup, Maiken Cavling
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712937/
https://www.ncbi.nlm.nih.gov/pubmed/33171634
http://dx.doi.org/10.3390/jof6040268
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author Risum, Malene
Helweg-Larsen, Jannik
Petersen, Søren Lykke
Kampmann, Peter
Overgaard, Ulrik Malthe
El Fassi, Daniel
Nielsen, Ove Juul
Brabrand, Mette
Rubek, Niclas
Munksgaard, Lars
Severinsen, Marianne Tang
Nielsen, Bendt
Gertsen, Jan Berg
Gylfe, Åsa
Hjort, Ulla
Vourtsi, Angeliki
Hare, Rasmus Krøger
Arendrup, Maiken Cavling
author_facet Risum, Malene
Helweg-Larsen, Jannik
Petersen, Søren Lykke
Kampmann, Peter
Overgaard, Ulrik Malthe
El Fassi, Daniel
Nielsen, Ove Juul
Brabrand, Mette
Rubek, Niclas
Munksgaard, Lars
Severinsen, Marianne Tang
Nielsen, Bendt
Gertsen, Jan Berg
Gylfe, Åsa
Hjort, Ulla
Vourtsi, Angeliki
Hare, Rasmus Krøger
Arendrup, Maiken Cavling
author_sort Risum, Malene
collection PubMed
description Mucormycosis is a life threatening infection in patients with haematological disease. We introduced a Mucorales-PCR and an aggressive, multidisciplinary management approach for mucormycosis during 2016–2017 and evaluated patient outcomes in 13 patients diagnosed and treated in 2012–2019. Management principle: repeated surgical debridement until biopsies from the resection margins were clean as defined by negative Blankophor microscopy, Mucorales-PCR (both reported within 24 h), and cultures. Cultured isolates underwent EUCAST E.Def 9.3.1 susceptibility testing. Antifungal therapy (AFT) (mono/combination) combined with topical AFT (when possible) was given according to the minimal inhibitory concentration (MIC), severity of the infection, and for azoles, specifically, it was guided by therapeutic drug monitoring. The outcome was evaluated by case record review. All patients underwent surgery guided by diagnostic biopsies from tissue and resection margins (195 samples in total). Comparing 2012–2015 and 2016–2019, the median number of patients of surgical debridements was 3 and 2.5 and of diagnostic samples: microscopy/culture/PCR was 3/3/6 and 10.5/10/10.5, respectively. The sensitivity of microscopy (76%) and Mucorales-PCR (70%) were similar and microscopy was superior to that of culture (53%; p = 0.039). Initial systemic AFT was liposomal amphotericin B (n = 12) or posaconazole (n = 1) given as monotherapy (n = 4) or in combination with isavuconazole/posaconazole (n = 3/6) and terbinafine (n = 3). Nine patients received topical amphotericin B. All received isavuconazole or posaconazole consolidation therapy (n = 13). Mucormycosis related six month mortality was 3/5 in 2012–2015 and 0/7 patients in 2016–2019 (one patient was lost for follow-up). Implementation of combination therapy (systemic+topical AFT/combination systemic AFT) and aggressive surgical debridement guided by optimised diagnostic tests may improve the outcome of mucormycosis in haematologic patients.
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spelling pubmed-77129372020-12-04 Introduction of a Comprehensive Diagnostic and Interdisciplinary Management Approach in Haematological Patients with Mucormycosis: A Pre and Post-Intervention Analysis Risum, Malene Helweg-Larsen, Jannik Petersen, Søren Lykke Kampmann, Peter Overgaard, Ulrik Malthe El Fassi, Daniel Nielsen, Ove Juul Brabrand, Mette Rubek, Niclas Munksgaard, Lars Severinsen, Marianne Tang Nielsen, Bendt Gertsen, Jan Berg Gylfe, Åsa Hjort, Ulla Vourtsi, Angeliki Hare, Rasmus Krøger Arendrup, Maiken Cavling J Fungi (Basel) Article Mucormycosis is a life threatening infection in patients with haematological disease. We introduced a Mucorales-PCR and an aggressive, multidisciplinary management approach for mucormycosis during 2016–2017 and evaluated patient outcomes in 13 patients diagnosed and treated in 2012–2019. Management principle: repeated surgical debridement until biopsies from the resection margins were clean as defined by negative Blankophor microscopy, Mucorales-PCR (both reported within 24 h), and cultures. Cultured isolates underwent EUCAST E.Def 9.3.1 susceptibility testing. Antifungal therapy (AFT) (mono/combination) combined with topical AFT (when possible) was given according to the minimal inhibitory concentration (MIC), severity of the infection, and for azoles, specifically, it was guided by therapeutic drug monitoring. The outcome was evaluated by case record review. All patients underwent surgery guided by diagnostic biopsies from tissue and resection margins (195 samples in total). Comparing 2012–2015 and 2016–2019, the median number of patients of surgical debridements was 3 and 2.5 and of diagnostic samples: microscopy/culture/PCR was 3/3/6 and 10.5/10/10.5, respectively. The sensitivity of microscopy (76%) and Mucorales-PCR (70%) were similar and microscopy was superior to that of culture (53%; p = 0.039). Initial systemic AFT was liposomal amphotericin B (n = 12) or posaconazole (n = 1) given as monotherapy (n = 4) or in combination with isavuconazole/posaconazole (n = 3/6) and terbinafine (n = 3). Nine patients received topical amphotericin B. All received isavuconazole or posaconazole consolidation therapy (n = 13). Mucormycosis related six month mortality was 3/5 in 2012–2015 and 0/7 patients in 2016–2019 (one patient was lost for follow-up). Implementation of combination therapy (systemic+topical AFT/combination systemic AFT) and aggressive surgical debridement guided by optimised diagnostic tests may improve the outcome of mucormycosis in haematologic patients. MDPI 2020-11-08 /pmc/articles/PMC7712937/ /pubmed/33171634 http://dx.doi.org/10.3390/jof6040268 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Risum, Malene
Helweg-Larsen, Jannik
Petersen, Søren Lykke
Kampmann, Peter
Overgaard, Ulrik Malthe
El Fassi, Daniel
Nielsen, Ove Juul
Brabrand, Mette
Rubek, Niclas
Munksgaard, Lars
Severinsen, Marianne Tang
Nielsen, Bendt
Gertsen, Jan Berg
Gylfe, Åsa
Hjort, Ulla
Vourtsi, Angeliki
Hare, Rasmus Krøger
Arendrup, Maiken Cavling
Introduction of a Comprehensive Diagnostic and Interdisciplinary Management Approach in Haematological Patients with Mucormycosis: A Pre and Post-Intervention Analysis
title Introduction of a Comprehensive Diagnostic and Interdisciplinary Management Approach in Haematological Patients with Mucormycosis: A Pre and Post-Intervention Analysis
title_full Introduction of a Comprehensive Diagnostic and Interdisciplinary Management Approach in Haematological Patients with Mucormycosis: A Pre and Post-Intervention Analysis
title_fullStr Introduction of a Comprehensive Diagnostic and Interdisciplinary Management Approach in Haematological Patients with Mucormycosis: A Pre and Post-Intervention Analysis
title_full_unstemmed Introduction of a Comprehensive Diagnostic and Interdisciplinary Management Approach in Haematological Patients with Mucormycosis: A Pre and Post-Intervention Analysis
title_short Introduction of a Comprehensive Diagnostic and Interdisciplinary Management Approach in Haematological Patients with Mucormycosis: A Pre and Post-Intervention Analysis
title_sort introduction of a comprehensive diagnostic and interdisciplinary management approach in haematological patients with mucormycosis: a pre and post-intervention analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712937/
https://www.ncbi.nlm.nih.gov/pubmed/33171634
http://dx.doi.org/10.3390/jof6040268
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