Study of Management of Mucormycosis in COVID and Post-COVID Patients with Liposomal Amphotericin B its Outcome and Complications in a dedicated COVID Hospital from Eastern India.

Background: Mucormycosis, an invasive fungal infection caused by Mucorales, has emerged as a significant concern in COVID-19 patients, particularly in regions heavily affected by the pandemic. Liposomal Amphotericin B is the primary treatment modality for mucormycosis; however, data on its efficacy and safety in COVID-19-associated mucormycosis are limited. This prospective observational study aimed to evaluate the management of mucormycosis in COVID-19 and post-COVID patients treated with Liposomal Amphotericin B at a dedicated COVID-19 hospital in IGIMS, Patna from Eastern India. Primary objectives were the study of liposomal amphotericin for the initial treatment of mucormycosis and treatment outcomes. The secondary objective was to study various complications of Liposomal Amphotericin B therapy.

Methodology: In total, 121 adult patients diagnosed with mucormycosis and either active COVID-19 infection or in the post-COVID recovery phase were included in the study. The treatment outcomes, complications, and factors influencing patient prognosis were assessed. Data analysis was performed using SPSS statistical software, including logistic regression and Cox Proportional Hazards modelling.

Results: Most patients achieved resolution of mucormycosis infection (70.2%), but the mortality rate was notable at 24.8%. Adverse events including nephrotoxicity (20.7%), infusion-related reactions (12.4%), and electrolyte imbalances (33.1%) were prevalent. Logistic regression analysis identified that older age (p = 0.002), diabetes (p = 0.01), delayed treatment initiation (p = 0.001), higher doses of Amphotericin B (p = 0.04), and pre-existing renal impairment (p = 0.01) were significant predictors of treatment outcomes. Cox Proportional Hazards modelling showed a trend towards improved outcomes with longer treatment duration (p = 0.06).

Conclusion: This study provides added information into the management of mucormycosis in COVID-19 patients treated with Liposomal Amphotericin B. Despite achieving a relatively high-resolution rate, the significant mortality and complication rates underscore the challenges in managing this fungal infection.