BACKGROUND & AIMS:
: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.
背景与目标:
: 随着侵袭性毛霉菌病 (IM) 数量的增加,临床医生怀疑先前的伏立康唑会加重IM的发生率和严重程度,并相信联合抗真菌治疗可提高IM的生存率。为了比较在伏立康唑商业上市之前和之后的eras中IM的累积发生率 (CI),严重程度和死亡率,分析了四个风险组 (血液/肿瘤恶性肿瘤 (H/O),干细胞移植 (SCT)) 1995年2011年的所有IM病例,实体器官移植 (SOT) 等),和两个eras,E1 (1995-2003) 和E2 (2004-2011)。在101例IM病例中,(79例证实,22例可能): 30例为E1 (3.3/年),71例为E2 (8.9/年)。在era之间,H/O或SCT的比例从47% 上升到73%,而 “其他” 从33% 下降到11% (P = 0.036)。在eras之间,IM的CI在SCT (P = 0.27) 或SOT (P = 0.30) 中没有显着增加,并且解剖位置 (P = 0.122) 和手术清创 (P = 0.200) 的模式相似。在E2中,接受两性霉素-棘皮素联合治疗的患者明显更多 (31% vs. 5%,P = 0.01); 然而,90天生存率没有改善 (54% vs. 59%,P = 0.67)。自2003以来,IM的上升反映了越来越多的风险,而不是以前使用伏立康唑。经常联合抗真菌治疗并不能提高生存率。