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Mucormycosis in Australia: Contemporary epidemiology and outcomes
Journal article   Open access   Peer reviewed

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, …
Clinical Microbiology and Infection, Vol.22(9), pp.775-781
2016
DOI: https://doi.org/10.1016/j.cmi.2016.01.005
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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.

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Collaboration types
Domestic collaboration
Citation topics
1 Clinical & Life Sciences
1.148 Medical Mycology
1.148.94 Antifungal Strategies
Web Of Science research areas
Infectious Diseases
Microbiology
ESI research areas
Immunology
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