METHODS: We conducted a retrospective study of hematologic patients suffered from mucormycosis and treated with monotherapy [amphotericin B (AmB) or posaconazole] or combination therapy (AmB and posaconazole). The primary outcome was 84-day all-cause mortality after diagnosis.
RESULTS: Ninety-five patients were included, with \"proven\" (n = 27), \"probable\" (n = 16) mucormycosis confirmed by traditional diagnostic methods, and \"possible\" (n = 52) mucormycosis with positive mNGS results. The mortality rate at 84 days was 44.2%. Possible + mNGS patients and probable patients had similar diagnosis processes, overall survival rates (44.2% vs 50.0%, p = 0.685) and overall response rates to effective drugs (44.0% vs 37.5%, p = 0.647). Furthermore, the median diagnostic time was shorter in possible + mNGS patients than proven and probable patients (14 vs 26 days, p < 0.001). Combination therapy was associated with better survival compared to monotherapy at six weeks after treatment (78.8% vs 53.1%, p = 0.0075). Multivariate analysis showed that combination therapy was the protective factor (HR = 0.338, 95% CI: 0.162-0.703, p = 0.004), though diabetes (HR = 3.864, 95% CI: 1.897-7.874, p < 0.001) and hypoxemia (HR = 3.536, 95% CI: 1.874-6.673, p < 0.001) were risk factors for mortality.
CONCLUSIONS: Mucormycosis is a life-threatening infection. Early management of diabetes and hypoxemia may improve the prognosis. Exploring effective diagnostic and treatment methods is important, and combination antifungal therapy seems to hold potential benefits.
方法:我们对接受单药治疗[两性霉素B(AmB)或泊沙康唑]或联合治疗(AmB和泊沙康唑)的血液病患者进行了回顾性研究。主要结果是诊断后84天全因死亡率。
结果:纳入95例患者,带有“已证明”(n=27),“可能”(n=16)通过传统诊断方法确认的毛霉菌病,和“可能”(n=52)mNGS结果阳性的毛霉菌病。84天死亡率为44.2%。可能+mNGS患者和可能患者的诊断过程相似,总生存率(44.2%vs50.0%,p=0.685)和对有效药物的总体反应率(44.0%vs37.5%,p=0.647)。此外,可能+mNGS患者的中位诊断时间比确诊和可能患者短(14vs26天,p<0.001)。与单一疗法相比,联合疗法在治疗后6周具有更好的生存率(78.8%vs53.1%,p=0.0075)。多因素分析显示联合治疗是保护因素(HR=0.338,95%CI:0.162-0.703,p=0.004),尽管糖尿病(HR=3.864,95%CI:1.897-7.874,p<0.001)和低氧血症(HR=3.536,95%CI:1.874-6.673,p<0.001)是死亡的危险因素。
结论:毛霉菌病是一种危及生命的感染。糖尿病和低氧血症的早期治疗可以改善预后。探索有效的诊断和治疗方法很重要,联合抗真菌治疗似乎具有潜在的益处。