Mucormycosis in Australia: contemporary epidemiology and outcomes

K. J. Kennedy, K. Daveson, M.A. Slavin, S. J. van Hal, T. C. Sorrell, A. Lee, D. J. Marriott, B. Chapman, C. L. Halliday, K. Hajkowicz, E. Athan, N. Bak, E. Cheong, C. H. Heath, C.O. Morrissey, S. Kidd, R. Beresford, C. Blyth, T. M. Korman, J. O. RobinsonW Meyer, S. C. -A. Chen, on behalf of the Australia and New Zealand Mycoses Interest Group of the Australasian Society for Infectious Diseases

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Abstract

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.

Original languageEnglish
Pages (from-to)775-781
Number of pages7
JournalClinical Microbiology and Infection
Volume22
Issue number9
DOIs
Publication statusPublished - 1 Sep 2016

Keywords

  • Apophysomyces
  • epidemiology
  • mortality
  • Mucorales
  • mucormycete
  • mucormycosis
  • Rhizopus
  • Saksenaea
  • zygomycosis

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