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. 2020 Nov 8;6(4):268.
doi: 10.3390/jof6040268.

Introduction of a Comprehensive Diagnostic and Interdisciplinary Management Approach in Haematological Patients with Mucormycosis: A Pre and Post-Intervention Analysis

Malene Risum  1 , Jannik Helweg-Larsen  2 , Søren Lykke Petersen  3 , Peter Kampmann  3 , Ulrik Malthe Overgaard  3 , Daniel El Fassi  4   5 , Ove Juul Nielsen  3 , Mette Brabrand  6 , Niclas Rubek  7 , Lars Munksgaard  8 , Marianne Tang Severinsen  9   10 , Bendt Nielsen  11 , Jan Berg Gertsen  12 , Åsa Gylfe  13 , Ulla Hjort  14 , Angeliki Vourtsi  15 , Rasmus Krøger Hare  1 , Maiken Cavling Arendrup  1   5   16
Affiliations

Introduction of a Comprehensive Diagnostic and Interdisciplinary Management Approach in Haematological Patients with Mucormycosis: A Pre and Post-Intervention Analysis

Malene Risum et al. J Fungi (Basel). .

Abstract

Mucormycosis is a life threatening infection in patients with haematological disease. We introduced a Mucorales-PCR and an aggressive, multidisciplinary management approach for mucormycosis during 2016-2017 and evaluated patient outcomes in 13 patients diagnosed and treated in 2012-2019. Management principle: repeated surgical debridement until biopsies from the resection margins were clean as defined by negative Blankophor microscopy, Mucorales-PCR (both reported within 24 h), and cultures. Cultured isolates underwent EUCAST E.Def 9.3.1 susceptibility testing. Antifungal therapy (AFT) (mono/combination) combined with topical AFT (when possible) was given according to the minimal inhibitory concentration (MIC), severity of the infection, and for azoles, specifically, it was guided by therapeutic drug monitoring. The outcome was evaluated by case record review. All patients underwent surgery guided by diagnostic biopsies from tissue and resection margins (195 samples in total). Comparing 2012-2015 and 2016-2019, the median number of patients of surgical debridements was 3 and 2.5 and of diagnostic samples: microscopy/culture/PCR was 3/3/6 and 10.5/10/10.5, respectively. The sensitivity of microscopy (76%) and Mucorales-PCR (70%) were similar and microscopy was superior to that of culture (53%; p = 0.039). Initial systemic AFT was liposomal amphotericin B (n = 12) or posaconazole (n = 1) given as monotherapy (n = 4) or in combination with isavuconazole/posaconazole (n = 3/6) and terbinafine (n = 3). Nine patients received topical amphotericin B. All received isavuconazole or posaconazole consolidation therapy (n = 13). Mucormycosis related six month mortality was 3/5 in 2012-2015 and 0/7 patients in 2016-2019 (one patient was lost for follow-up). Implementation of combination therapy (systemic+topical AFT/combination systemic AFT) and aggressive surgical debridement guided by optimised diagnostic tests may improve the outcome of mucormycosis in haematologic patients.

Keywords: Mucorales; haematology; mucormycosis; neutropenia and mortality.

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Conflict of interest statement

Outside the current work within the past five years: M.R. has over the past 5 years received a speaker honoraria from Bristol Myers Squibb and travel grants from Gilead. J.H.L. Nothing to declare over the past 5 years. S.L.P. has over the past 5 years received travel grants from Gilead and Novartis and has served as a member of a Novartis Advisory Board. P.K. has over the past 5 years received travel expenses and congress fees from uniQure, Pfizer, and Novartis and a speaker fee from UniQure. U.M.O. No conflicts of interests relating to the actual study. Speaker honoraria not related to the current study over the 5 past years have been received from Alexion, Astellas, Sanofi, and Amgen. D.E.F. has served as a PI on a Gilead sponsored trial without relation to antifungal therapy. O.J.N. Nothing to declare over the past 5 years. M.B. Nothing to declare over the past years. N.R. Nothing to declare over the past 5 years. L.M. has over the past 5 years received a travel grant from abbvie. M.S. Nothing to declare over the past 5 years. B.N. Nothing to declare over the past 5 years. J.B.G. over the past 5 years has received travel grants from Gilead and Roche and speaker honoraria from Gilead. Å.G. Nothing to declare over the past 5 years. U.H. has over the past 5 years received speaker’s honoraria from Boehringer Ingelheim. A.V. Nothing to declare over the past 5 years. R.K.H. over the past 5 years has received an unrestricted research grant and a travel grant from Gilead. M.C.A. over the past 5 years has received research grants/contract work (paid to the SSI) from Amplyx, Basilea, Cidara, F2G, Gilead, Novabiotics, Scynexis, and T2Biosystems and speaker honoraria (personal fee) from Astellas, Gilead, MSD, SEGES, and Pfizer. She is the current chairman of the EUCAST-AFST.

References

    1. Prakash H., Chakrabarti A. Global Epidemiology of Mucormycosis. J. Fungi. 2019;5:26. doi: 10.3390/jof5010026. - DOI - PMC - PubMed
    1. Roden M.M., Zaoutis T.E., Buchanan W.L., Knudsen T.A., Sarkisova T.A., Schaufele R.L., Sein M., Chiou C.C., Chu J.H., Kontoyiannis D.P., et al. Epidemiology and outcome of zygomycosis: A review of 929 reported cases. Clin. Infect Dis. 2005;41:634–653. doi: 10.1086/432579. - DOI - PubMed
    1. Sipsas N.V., Gamaletsou M.N., Anastasopoulou A., Kontoyiannis D.P. Therapy of Mucormycosis. J. Fungi. 2018;4:90. doi: 10.3390/jof4030090. - DOI - PMC - PubMed
    1. Skiada A., Lass-Floerl C., Klimko N., Ibrahim A., Roilides E., Petrikkos G. Challenges in the diagnosis and treatment of mucormycosis. Med Mycol. 2018;56:S93–S101. doi: 10.1093/mmy/myx101. - DOI - PMC - PubMed
    1. Kennedy K., Daveson K., Slavin M., Van Hal S., Sorrell T., Lee A., Marriott D., Chapman B., Halliday C., Hajkowicz K., et al. Mucormycosis in Australia: Contemporary epidemiology and outcomes. Clin. Microbiol. Infect. 2016;22:775–781. doi: 10.1016/j.cmi.2016.01.005. - DOI - PubMed

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