184. Review of Treatment Regimens for Mucormycosis in a Las Vegas County Hospital Between 2013-2017
Session: Poster Abstract Session: Clinical Mycology
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • Mucor Poster Final Draft.pdf (1.7 MB)
  • Background: Mucormycosis (MC) is a group of invasive fungal infections with a mortality rate approaching 100% in disseminated disease. The incidence of MC is low, with one study estimating 500 cases/year in the U.S., making optimal treatment difficult to identify. Liposomal amphotericin B (L-ampho), along with aggressive surgical intervention, is the first-line treatment for MC. Isavuconazole (ISA) and posaconazole (POSA) are newer azoles used as salvage therapy in patients not improving with L-ampho. Limited data is available about the use of L-ampho in combination with ISA or POSA as an initial treatment regimen, but aggressive treatment empirically may increase favorable outcomes.

    Methods: We performed a retrospective review of patients diagnosed with MC from 2013-2017 at University Medical Center of Southern Nevada in Las Vegas, Nevada. Data collected included patient demographics, comorbidities, and predisposing risk factors as well as treatment regimens. Patients were evaluated for outcome after treatment therapy with monotherapy (L-ampho, POSA or ISA) or combination therapy (L-ampho with ISA).

    Results: From 2013 to 2017, 7 cases of MC were identified – 5 rhinocerebral (RC), 1 cutaneous (CT), and 1 pulmonary (PM). The most common risk factor was uncontrolled diabetes (5/7), followed by HIV (2/7) and non-Hodgkin lymphoma (1/7). 57% of patients received monotherapy and 43% received combination therapy (L-ampho/ISA). All the patients receiving combination therapy had RC. 71% of patients survived to discharge regardless of treatment regimen. 100% of combination therapy patients survived to discharge, whereas 50% of monotherapy patients survived to discharge. The 2 mortalities were patients with PM and CT MC.

    Conclusion: MC is a rare infection with high mortality. For this reason, we are using ISA in combination with L-ampho as initial treatment to improve clinical outcomes. With our limited experience, combination therapy showed better rates of survival to discharge, without increasing adverse events. Our data suggests use of combination therapy may improve outcomes in MC, but a larger sample of patients treated with initial combination therapy is required to strengthen conclusions about patient outcomes.

    Angela Villamagna, M.D.1, Ian Adrian Frani, B.S.N., M.D.1, Kimberly D. Leuthner, PharmD, FIDSA2 and Shadaba Asad, MD3, (1)Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV, (2)University Medical Center of Southern Nevada, Las Vegas, NV, (3)Epidemiology, University Medical Center of Southern Nevada, Las Vegas, NV

    Disclosures:

    A. Villamagna, None

    I. A. Frani, None

    K. D. Leuthner, None

    S. Asad, None

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