Mucormycosis after allogeneic haematopoietic stem cell transplantation: a French Multicentre Cohort Study (2003-2008).

Service d'Hématologie- Greffe, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris  Université Paris-Diderot, Sorbonne Cité, Paris  Service des Maladies infectieuses et Tropicales, Centre d'Infectiologie Necker Pasteur, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris  Centre National de Référence Mycologie et Antifongiques, Institut Pasteur, Paris  Département de Bioinformatique Médicale, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris  Unité de Parasitologie-Mycologie, Laboratoire de Microbiologie, HEGP, Assistance Publique-Hôpitaux de Paris, Paris  Service de Pneumologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris  Service d'Hématologie, Centre Hospitalier Universitaire Nancy, Nancy  Service de Parasitologie-Mycologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris  Département d'Oncologie et d'Hématologie, Hôpitaux Universitaires de Strasbourg, Strasbourg  Service d'Hématologie, Centre Hospitalier Universitaire, Besançon,  Service d'Hématologie, Centre Hospitalier Universitaire Nantes, Nantes  Service d'Hématologie, Centre Hospitalier Universitaire Lyon, Lyon  Service d'Hématologie, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, et Université Paris-Est, Créteil  Service d'Hématologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris  Service d'Hématologie, Centre Hospitalier Universitaire Saint-Etienne, Saint-Etienne  Service de Pneumologie, Hôpital Foch, Suresnes and  Service d'Hématologie, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France.
Clinical Microbiology and Infection (Impact Factor: 5.2). 05/2012; 18(10):E396-E400. DOI: 10.1111/j.1469-0691.2012.03908.x
Source: PubMed

ABSTRACT Clin Microbiol Infect 2012; 18: E396-E400 ABSTRACT: We conducted a nationwide retrospective study to evaluate clinical characteristics and outcome of mucormycosis among allogeneic haematopoietic stem cell transplant recipients. Twenty-nine patients were diagnosed between 2003 and 2008. Mucormycosis occurred at a median of 225 days after allogeneic haematopoietic stem cell transplant, and as a breakthrough infection in 23 cases. Twenty-six patients were receiving steroids, mainly for graft-versus-host disease treatment, while ten had experienced a prior post-transplant invasive fungal infection. Twenty-six patients received an antifungal treatment; surgery was performed in 12. Overall survival was 34% at 3 months and 17% at 1 year.

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    ABSTRACT: As invasive mucormycosis (IM) numbers rise, clinicians suspect prior voriconazole worsens IM incidence and severity, and believe combination anti-fungal therapy improves IM survival. To compare the cumulative incidence (CI), severity and mortality of IM in eras immediately before and after the commercial availability of voriconazole all IM cases from 1995 to 2011 were analysed across four risk-groups (hematologic/oncologic malignancy (H/O), stem cell transplantation (SCT), solid organ transplantation (SOT) and other), and two eras, E1 (1995–2003) and E2, (2004–2011). Of 101 IM cases, (79 proven, 22 probable): 30 were in E1 (3.3/year) and 71 in E2 (8.9/year). Between eras, the proportion with H/O or SCT rose from 47% to 73%, while ‘other’ dropped from 33% to 11% (P = 0.036). Between eras, the CI of IM did not significantly increase in SCT (P = 0.27) or SOT (P = 0.30), and patterns of anatomic location (P = 0.122) and surgical debridement (P = 0.200) were similar. Significantly more patients received amphotericin-echinocandin combination therapy in E2 (31% vs. 5%, P = 0.01); however, 90-day survival did not improve (54% vs. 59%, P = 0.67). Since 2003, the rise of IM reflects increasing numbers at risk, not prior use of voriconazole. Frequent combination of anti-fungal therapy has not improved survival.
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