1446. Combination anti-fungal therapy is not associated with improved survival in patients with  invasive mucormycosis
Session: Poster Abstract Session: Fungal Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Final Poster Mucor 1446.pdf (613.9 kB)
  • Background:   Cases of invasive mucormycosis (IM) have risen in the past decade. The impact of voriconazole (vori) prophylaxis on the cumulative incidence (CI) of IM in definable populations is unclear. The survival benefit of combination antifungal therapy using amphotericin-based agents (ABA) with an echinocandin (EC) is not well defined. 

    Methods: We reviewed all cases of IM from 1995 to 2011. We divided these into 2 eras: E1 from 1995-2003 before vori, E2 from 2004-2011 when vori was available. We defined 4 at-risk groups: solid organ transplant patients (SOT); stem cell transplant patients (SCT); non-transplant patients with hematologic or oncologic disorders (H/O); non-transplant, non-H/O patients. We abstracted and compared clinical, mycologic, treatment, and outcome data.

    Results:

    Total of 104 cases (80 proven, 22 probable, 2 possible) were recorded. 30 cases were in E1 and 74 cases in E2. No significant difference was noted in age (p=0.24), gender (p=0.065), or rates of pure IM vs. mixed mold infection  (p=0.201), between E1 and E2.

    The CI (Kaplan-Meier) of IM was not significantly different between E1 and E2 for SOT (p=0.30) and SCT (p=0.27). Between E1 and E2, there were significant differences in the proportion of IM cases with neutropenia at diagnosis  (21% vs. 43%; p=. 033), in prior use of any antifungal agent (50% vs. 74%, p=0.0170); and in the spectrum of prior antifungal used (yeast only, 80% vs. 25%; molds but not mucor, 7% vs. 73%; molds including mucor, 13% vs. 2%; p<. 001).

    No significant differences were seen in rates of IM across the 4 at-risk groups , or in rates of rhinocerebral or disseminated disease, or rates of surgical debridement between E1 and E2. More patients received combination regimens (ABA with EC and/or posaconazole) in the latter era (5% vs. 32% in E1 vs. E2, p=. 035).

    Survival rates for all IM cases were 70% at 30-days and 59% at 90-days, and were not significantly different between E1 and E2, or across the 4 risk groups.

    Conclusion: Despite use of ABA-EC combination therapy in the past decade, survival from IM has not significantly improved. The CI of IM did not increase in SCT and SOT in the decade after vori became available.


    Maheen Abidi, MD1, Muhammad R. Sohail, MD2, Nathan Cummins, MD3, Mark Wilhelm, MD4, Nancy L. Wengenack, PhD5, Lisa Brumble, MD6, Harshal Shah, M.D.7, D. Jane Hata8, Ann E. McCullough, MD9, Amy Wendel Spiczka10, Shimon Kusne, MD11, Brian Lahr, MS12,13 and Randall C. Walker, MD5, (1)Infectious Disease, Mayo Clinic, Rochester, MN, (2)Mayo School of Graduate Medical Education, Rochester, MN, (3)Infectious Diseases, Mayo Clinic, Rochester, MN, (4)Mayo Clinic College of Medicine, rochester, MN, (5)Mayo Clinic, Rochester, MN, (6)Mayo Clinic Jacksonville, Jacksonville, FL, (7)Infectious Disease, Mayo Clinic, Jacksonville, FL, (8)Mayo Clinic, Jacksonville, FL, (9)Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ, (10)Mayo Clinic, Scottsdale, AZ, (11)Infectious Diseases, Mayo Clinic Arizona, Phoenix, AZ, (12)Mayo Clinic, rochester, MN, (13)Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN

    Disclosures:

    M. Abidi, None

    M. R. Sohail, None

    N. Cummins, None

    M. Wilhelm, None

    N. L. Wengenack, None

    L. Brumble, None

    H. Shah, None

    D. J. Hata, None

    A. E. McCullough, None

    A. Wendel Spiczka, None

    S. Kusne, None

    B. Lahr, None

    R. C. Walker, None

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