Mucormycosis in Australia: contemporary epidemiology and outcomes

被引：82

作者：

Kennedy, K. J. ^{[1
]}

Daveson, K. ^{[1
]}

Slavin, M. A. ^{[2
]}

van Hal, S. J. ^{[3
,4
]}

Sorrell, T. C. ^{[5
,6
]}

Lee, A. ^{[3
,4
]}

Marriott, D. J. ^{[7
]}

Chapman, B. ^{[8
,9
]}

Halliday, C. L. ^{[9
]}

Hajkowicz, K. ^{[10
]}

Athan, E. ^{[11
]}

Bak, N. ^{[12
]}

Cheong, E. ^{[13
]}

Heath, C. H. ^{[14
]}

Morrissey, C. O. ^{[15
,16
]}

Kidd, S. ^{[17
]}

Beresford, R. ^{[18
]}

Blyth, C. ^{[19
]}

Korman, T. M. ^{[16
,20
]}

Robinson, J. O. ^{[14
,21
,22
]}

Meyer, W. ^{[8
,9
]}

Chen, S. C-A ^{[9
,23
]}

机构：

[1] Australian Natl Univ, Dept Infect Dis & Microbiol, Canberra Hosp, Sch Med, Canberra, ACT, Australia

[2] Doherty Inst Infect & Immun, Dept Infect Dis, Peter MacCallum Canc Ctr, Victorian Infect Dis Serv, Melbourne, Vic, Australia

[3] Royal Prince Alfred Hosp, Dept Infect Dis, Sydney, NSW, Australia

[4] Royal Prince Alfred Hosp, Dept Microbiol, Sydney, NSW, Australia

[5] Univ Sydney, Ctr Infect Dis & Microbiol, Westmead Hosp, Sydney, NSW, Australia

[6] Univ Sydney, Marie Bashir Inst Infect Dis & Biosecur, Sydney, NSW, Australia

[7] St Vincents Hosp, Dept Microbiol & Infect Dis, Sydney, NSW, Australia

[8] Univ Sydney, Westmead Inst Med Res, Westmead, NSW, Australia

[9] Westmead Hosp, Ctr Infect Dis & Microbiol Lab Serv, ICPMR, Sydney, NSW, Australia

[10] Royal Brisbane & Womens Hosp, Dept Infect Dis, Brisbane, Qld, Australia

[11] Deakin Univ, Dept Infect Dis, Barwon Hlth, Geelong, Vic, Australia

[12] Royal Adelaide Hosp, Dept Infect Dis, Adelaide, SA, Australia

[13] Concord Hosp, Dept Infect Dis & Microbiol, Sydney, NSW, Australia

[14] Univ Western Australia, Dept Microbiol & Infect Dis, Royal Perth Hosp, Sch Med & Pharmacol, Perth, WA, Australia

[15] Alfred Hlth, Dept Infect Dis, Melbourne, Vic, Australia

[16] Monash Univ, Melbourne, Vic, Australia

[17] SA Pathol, Natl Mycol Reference Ctr, Adelaide, SA, Australia

[18] Liverpool Hosp, Dept Infect Dis & Microbiol, Sydney, NSW, Australia

[19] Univ Western Australia, Princess Margaret Hosp, Sch Paediat & Child Hlth, Perth, WA, Australia

[20] Monash Infect Dis, Melbourne, Vic, Australia

[21] Curtin Univ, Australian Collaborating Ctr Enterococcus & Staph, Sch Biomed Sci, Perth, WA, Australia

[22] Murdoch Univ, Sch Vet & Life Sci, Perth, WA, Australia

[23] Univ Sydney, Ctr Infect Dis & Microbiol, Sydney, NSW, Australia

来源：

CLINICAL MICROBIOLOGY AND INFECTION | 2016年 / 22卷 / 09期

关键词：

Apophysomyces; epidemiology; mortality; Mucorales; mucormycete; mucormycosis; Rhizopus; Saksenaea; zygomycosis; INVASIVE ZYGOMYCOSIS; FUNGAL-INFECTIONS; IDENTIFICATION; RHIZOPUS; DISEASES; FRANCE; DNA;

D O I：

10.1016/j.cmi.2016.01.005

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Mucormycosis is the second most common cause of invasive mould infection and causes disease in diverse hosts, including those who are immuno-competent. We conducted a multicentre retrospective study of proven and probable cases of mucormycosis diagnosed between 2004-2012 to determine the epidemiology and outcome determinants in Australia. Seventy-four cases were identified (63 proven, 11 probable). The majority (54.1%) were caused by Rhizopus spp. Patients who sustained trauma were more likely to have non-Rhizopus infections relative to patients without trauma (OR 9.0, p 0.001, 95% CI 2.1-42.8). Haematological malignancy (48.6%), chemotherapy (42.9%), corticosteroids (52.7%), diabetes mellitus (27%) and trauma (22.9%) were the most common co-morbidities or risk factors. Rheumatological/autoimmune disorders occurred in nine (12.1%) instances. Eight (10.8%) cases had no underlying co-morbidity and were more likely to have associated trauma (7/8; 87.5% versus 10/66; 15.2%; p<0.001). Disseminated infection was common (39.2%). Apophysomyces spp. and Saksenaea spp. caused infection in immuno-competent hosts, most frequently associated with trauma and affected sites other than lung and sinuses. The 180-day mortality was 56.7%. The strongest predictors of mortality were rheumatological/autoimmune disorder (OR = 24.0, p 0.038 95% CI 1.2-481.4), haematological malignancy (OR = 7.7, p 0.001, 95% CI 2.3-25.2) and admission to intensive care unit (OR = 4.2, p 0.02, 95% CI 1.3-13.8). Most deaths occurred within one month. Thereafter we observed divergence in survival between the haematological and non-haematological populations (p 0.006). The mortality of mucormycosis remains particularly high in the immuno-compromised host. Underlying rheumatological/autoimmune disorders are a previously under-appreciated risk for infection and poor outcome. K.J. Kennedy, CMI 2016; 22: 775 (C) 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

引用

页码：775 / 781

页数：7

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