Stability in the cumulative incidence, severity and mortality of 101 cases of invasive mucormycosis in high‐risk patients from 1995 to 2011: a comparison of eras immediately before and after the availability of voriconazole and echinocandin‐amphotericin combination therapies

Abstract

Background As invasive mucormycosis (IM) numbers rise, clinicians suspect prior voriconazole worsens IM incidence and severity, and believe combination anti-fungal therapy improves IM survival. Objectives To compare the cumulative incidence (CI), severity and mortality of IM in eras immediately before and after the commercial availability of voriconazole. Methods All IM cases from 1995–2011 were analyzed 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). Results 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=. 01); however, 90-day survival did not improve (54% vs. 59%, p=0.67). Conclusions Since 2003, the rise of IM reflects increasing numbers at risk, not prior use of voriconazole. Frequent combination anti-fungal therapy has not improved survival.

Mucormycosis in lung transplant recipients: A systematic review of the literature and a case series

“…We found reports on 121 cases of mucormycosis in LTR. Data regarding infection site and outcome were available for 53 patients (Figure ), whereas detailed clinical and therapeutic data were available for 34 patients, for which the data regarding our series were also added, to total 40 patients (Table ) . Thirty‐four of the 121 published cases referred to airway colonization with Mucorales without clinical, radiological, or histological evidence of invasive disease; however, some cases affected management, leading to reduced immunosuppression or to initiation of antifungal therapy .…”

Diagnosis and Treatment of Mucormycosis in Patients withHematological Malignancies［Translated Article］

“…Concomitant use of echinocandins with amphtericin B formulations has also been reported to show improved efficacy, because synergetic effect was obtained in spite of little in vivo activity of echinocandins against Mucorales 37) . However, the effectiveness of combination therapy with echinocandins and amphotericin B formulations is not confirmed in other studies 38,39) , and therefore it is still controversial. At least in the cases where the first-line therapy is ineffective, the combination therapy is worthy of consideration.…”

Echinocandins Versus Dated Antifungals in Combination Against Opportunistic Mycotic Infections

“…However, between periods, the cumulative prevalence of invasive infections did not appreciably escalated in stem cell transplant recipients (p=0.27) or solid organ transplant recipients (p=0.30). Notably, more patients were given amphotericin-echinocandin combination therapy in P2 (31% vs. 5%, p=0.01); though, no improvement was observed during 90-days survival (54% vs. 59%, p=0.67) [34].…”

“…Instead of combination therapy, researchers analyzed the decline of fungal load in kidneys during disseminated infection, was appreciably improved when LAmpB was administered previous to CAS instead of CAS was given first (sequential therapy) [34].…”