Short intravenous amphotericin B followed by oral posaconazole using a simple, stratified treatment approach for diabetes or COVID-19-associated rhino-orbito-cerebral mucormycosis: a prospective cohort study

被引：7

作者：

Manesh, Abi ^{[1
]}

Devasagayam, Emily ^{[1
]}

Bhanuprasad, Kundakarla ^{[1
]}

Varghese, Lalee ^{[2
]}

Kurien, Regi ^{[2
]}

Cherian, Lisa M. ^{[2
]}

Dayanand, Divya ^{[1
]}

George, Mithun M. ^{[1
]}

Kumar, Selwyn S. ^{[1
]}

Karthik, Rajiv ^{[1
]}

Vanjare, Harshad ^{[3
]}

Peter, Jayanthi ^{[4
]}

Michael, Joy S. ^{[5
]}

Thomas, Meera ^{[6
]}

Mathew, Binu S. ^{[7
]}

Samuel, Prasanna ^{[8
]}

Peerawaranun, Pimnara ^{[9
]}

Mukaka, Mavuto ^{[9
,10
]}

Rupa, Vedantam ^{[2
]}

Varghese, George M. ^{[1
]}

机构：

[1] Christian Med Coll & Hosp, Dept Infect Dis, Vellore 632004, Tamil Nadu, India

[2] Christian Med Coll & Hosp, Dept ENT & Rhinol 3, Vellore, Tamil Nadu, India

[3] Christian Med Coll & Hosp, Dept Radiodiag, Vellore, Tamil Nadu, India

[4] Christian Med Coll & Hosp, Dept Ophthalmol, Vellore, Tamil Nadu, India

[5] Christian Med Coll & Hosp, Dept Clin Microbiol, Vellore, Tamil Nadu, India

[6] Christian Med Coll & Hosp, Dept Pathol, Vellore, Tamil Nadu, India

[7] Christian Med Coll & Hosp, Dept Clin Pharmacol, Vellore, Tamil Nadu, India

[8] Christian Med Coll & Hosp, Dept Biostat, Vellore, Tamil Nadu, India

[9] Mahidol Univ, Fac Trop Med, Mahidol Oxford Trop Med Res Unit, Bangkok, Thailand

[10] Univ Oxford, Ctr Trop Med & Global Hlth, Oxford, England

来源：

CLINICAL MICROBIOLOGY AND INFECTION | 2023年 / 29卷 / 10期

基金：

英国惠康基金;

关键词：

Diabetes -associated mucormycosis; Lipid emulsion amphotericin B; Oral posaconazole; Rhino-orbito-cerebral; Short intravenous amphotericin B; LIPID COMPLEX;

D O I：

10.1016/j.cmi.2023.06.017

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Objectives: To evaluate the efficacy and safety of short-course intravenous amphotericin B followed by sustained release posaconazole tablets for diabetes or COVID-19-associated rhino-orbito-cerebral mucormycosis.Methods: This prospective, pragmatic study included adults with diabetes or COVID-19-associated rhinoorbito-cerebral mucormycosis. Patients received short (7-14 days) or long (15-28 days) intravenous antifungal therapy (short intravenous antifungal treatment [SHIFT] or long intravenous antifungal treatment [LIFT], respectively) depending on the presence or absence of brain involvement. All patients received step-down posaconazole tablets, debridement, and glycemic control. The primary outcome was the treatment success at week 14, which was determined by assessing survival and the absence of disease progression through clinical evaluation and nasal endoscopy. Log-binomial regression analysis (risk ratio and 95% CI) was performed to assess factors associated with the primary outcome.Results: Intravenous therapy was administered to 251 participants: SHIFT, 205 (median duration, 13 days); LIFT, 46 (median duration, 22 days). Treatment success at 3 months was 88% (217/248; 95% CI, 83-91%): SHIFT group, 93% (189/203; 89-96%); LIFT group, 62% (28/45; 47-76%). All-cause mortality was 12% (30/251): SHIFT group, 6% (13/205); LIFT group, 37% (17/46). Age (aRR [95% CI]: 1.02 [1.00-1.05]; p 0.027), diabetic ketoacidosis at presentation (2.32 [1.20-4.46]; p 0.012), glycated haemoglobin A1c (1.19 [1.03-1.39]; p 0.019), stroke (3.93 [1.94-7.95]; p 0.0001), and brain involvement (5.67 [3.05 -10.54]; p < 0.0001) were independently associated with unsuccessful outcomes.Discussion: : Short intravenous amphotericin B with step-down posaconazole tablets should be further studied as primary treatment option for diabetes or COVID-19-associated mucormycosis in randomized

引用

页码：1298 / 1305

页数：8

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