{"title":"Longitudinal Epidemiology of Mucormycosis Within the Veterans Health Administration: A Retrospective Cohort Study Over a 20-Year Period.","authors":"Nirmal Muthukumarasamy, Hiroyuki Suzuki","doi":"10.1111/myc.13794","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Mucormycosis is a rare but critical infection. Due to its rarity, there is scarce evidence about the longitudinal changes in the epidemiology of mucormycosis in the US.</p><p><strong>Objectives: </strong>We investigated the longitudinal epidemiology, detailed clinical characteristics, treatment and outcomes of patients with mucormycosis within the US Veterans Health Administration (VHA) over 20-year period.</p><p><strong>Patients/methods: </strong>All adult patients who were admitted to an acute-care hospital with a diagnosis of mucormycosis within the VHA from January 2003 to December 2022.</p><p><strong>Results: </strong>Our study included 201 patients from 68 hospitals. Incidence rates of mucormycosis increased from 1.9 per 100,000 hospitalisations in 2003 to 3.3 per 100,000 hospitalisations in 2022, with a peak incidence at 5.9 per 100,000 hospitalisations in 2021, when the Delta wave of COVID-19 hit the US. Rhino-orbital (37.3%) and pulmonary mucormycosis (36.8%) were the most common types of infection. Diabetes mellitus (59.1%) and leukaemia (28.9%) were most common comorbidities predisposing to mucormycosis. Use of posaconazole or isavuconazole increased over time. The 90-day and 1-year mortalities were 35.3% and 49.8%, respectively. The mortality was lower in more recent years (2013-2017, 2018-2022) compared to earlier years (2003-2007). Age ≥65 (adjusted odds ratio [aOR]: 3.47, 95% CI 1.59-7.40), leukaemia as a comorbidity (aOR: 2.66, 95% CI 1.22-5.89) and central nervous system infection (aOR: 10.59, 95% CI 2.81-44.57) were significantly associated with higher 90-day mortality.</p><p><strong>Conclusions: </strong>Our longitudinal cohort study suggests the increasing incidence rates but lower mortality of mucormycosis over this 20-year period.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"67 9","pages":"e13794"},"PeriodicalIF":4.1000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Mycoses","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/myc.13794","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"DERMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Mucormycosis is a rare but critical infection. Due to its rarity, there is scarce evidence about the longitudinal changes in the epidemiology of mucormycosis in the US.
Objectives: We investigated the longitudinal epidemiology, detailed clinical characteristics, treatment and outcomes of patients with mucormycosis within the US Veterans Health Administration (VHA) over 20-year period.
Patients/methods: All adult patients who were admitted to an acute-care hospital with a diagnosis of mucormycosis within the VHA from January 2003 to December 2022.
Results: Our study included 201 patients from 68 hospitals. Incidence rates of mucormycosis increased from 1.9 per 100,000 hospitalisations in 2003 to 3.3 per 100,000 hospitalisations in 2022, with a peak incidence at 5.9 per 100,000 hospitalisations in 2021, when the Delta wave of COVID-19 hit the US. Rhino-orbital (37.3%) and pulmonary mucormycosis (36.8%) were the most common types of infection. Diabetes mellitus (59.1%) and leukaemia (28.9%) were most common comorbidities predisposing to mucormycosis. Use of posaconazole or isavuconazole increased over time. The 90-day and 1-year mortalities were 35.3% and 49.8%, respectively. The mortality was lower in more recent years (2013-2017, 2018-2022) compared to earlier years (2003-2007). Age ≥65 (adjusted odds ratio [aOR]: 3.47, 95% CI 1.59-7.40), leukaemia as a comorbidity (aOR: 2.66, 95% CI 1.22-5.89) and central nervous system infection (aOR: 10.59, 95% CI 2.81-44.57) were significantly associated with higher 90-day mortality.
Conclusions: Our longitudinal cohort study suggests the increasing incidence rates but lower mortality of mucormycosis over this 20-year period.
背景：粘孢子菌病是一种罕见但严重的传染病。由于其罕见性，有关美国粘孢子菌病流行病学纵向变化的证据很少：我们调查了美国退伍军人健康管理局（VHA）20年来粘孢子菌病患者的纵向流行病学、详细临床特征、治疗和结果：2003年1月至2022年12月期间，退伍军人健康管理局急症医院收治的所有诊断为粘孢子菌病的成年患者：我们的研究包括来自68家医院的201名患者。粘孢子菌病的发病率从2003年的每10万例住院患者中1.9例上升到2022年的每10万例住院患者中3.3例，其中2021年的发病率最高，为每10万例住院患者中5.9例，当时COVID-19的Delta波袭击了美国。鼻眶病（37.3%）和肺粘液瘤病（36.8%）是最常见的感染类型。糖尿病（59.1%）和白血病（28.9%）是导致粘孢子菌病的最常见合并症。随着时间的推移，使用泊沙康唑或异唑康唑的情况有所增加。90天和1年的死亡率分别为35.3%和49.8%。与较早年份（2003-2007年）相比，最近几年（2013-2017年、2018-2022年）的死亡率较低。年龄≥65岁（调整赔率[aOR]：3.47，95% CI 1.59-7.40）、合并白血病（aOR：2.66，95% CI 1.22-5.89）和中枢神经系统感染（aOR：10.59，95% CI 2.81-44.57）与较高的90天死亡率显著相关：我们的纵向队列研究表明，在这20年中，粘孢子菌病的发病率在上升，但死亡率却在下降。
期刊介绍：
The journal Mycoses provides an international forum for original papers in English on the pathogenesis, diagnosis, therapy, prophylaxis, and epidemiology of fungal infectious diseases in humans as well as on the biology of pathogenic fungi.
Medical mycology as part of medical microbiology is advancing rapidly. Effective therapeutic strategies are already available in chemotherapy and are being further developed. Their application requires reliable laboratory diagnostic techniques, which, in turn, result from mycological basic research. Opportunistic mycoses vary greatly in their clinical and pathological symptoms, because the underlying disease of a patient at risk decisively determines their symptomatology and progress. The journal Mycoses is therefore of interest to scientists in fundamental mycological research, mycological laboratory diagnosticians and clinicians interested in fungal infections.
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