Background
Methods
Data collection
Definitions
Microbiological diagnosis
Statistical analysis
Ethical considerations
Results
Demographic characteristics
Demographic characteristics | Study population (n=74) | Survivors (n=21) | Non-survivors (n=53) | p-value |
---|---|---|---|---|
Age, years, mean (SD)a | 50.6 (16.6) | 39.5 (17.5) | 55.0 (14.1) | 0.001 |
Sex-ratio (H/F) | 1.96 | 1.63 | 2.12 | 0.78 |
Underlying disease | ||||
Hematological malignancies, n (%) | 41 (55.4) | 7 (33.3) | 34 (64.2) | 0.02 |
Acute myeloid leukemia, n (%) | 15 (20.3) | 4 (19.0) | 11 (20.8) | 1 |
Acute lymphoblastic leukemia, n (%) | 10 (13.5) | 2 (9.5) | 8 (15.1) | 0.71 |
Lymphoma, n (%) | 8 (10.8) | 0 (0) | 8 (15.1) | 0.10 |
Multiple myeloma, n (%) | 2 (2.7) | 0 (0) | 2 (3.8) | 1 |
Myelodysplastic syndrome, n (%) | 2 (2.7) | 0 (0) | 2 (3.8) | 1 |
Other, n (%) | 4 (5.4) | 1 (4.8) | 3 (5.7) | 0.84 |
Allogenic HSCT, n (%) | 16 (21.6) | 1 (4.8) | 15 (28.3) | 0.03 |
Autologous HSCT, n (%) | 7 (9.5) | 1 (4.8) | 6 (11.3) | 0.67 |
Solid malignancies, n (%) | 4 (5.4) | 2 (9.5) | 2 (3.8) | 0.32 |
SOT, n (%) | 9 (12.2) | 2 (9.5) | 7 (13.2) | 1 |
Inflammatory disease, n (%) | 2 (2.7) | 1 (4.8) | 1 (1.9) | 0.49 |
Systemic steroids, n (%) | 30 (40.5) | 2 (9.5) | 28 (52.8) | < 0.001 |
Diabetes, n (%) | 11 (14.9) | 0 (0) | 11 (20.8) | 0.03 |
Other condition, n (%) | ||||
Chronic alcoholism, n (%) | 8 (10.8) | 2 (9.5) | 6 (11.3) | 1 |
Malnutrition, n (%) | 24 (32.4) | 3 (14.3) | 21 (39.6) | 0.05 |
Drug addiction, n (%) | 1 (1.4) | 1 (4.8) | 0 (0) | 0.28 |
Chronic renal failure, n (%) | 7 (9.5) | 0 (0) | 7 (13.2) | 0.18 |
Respiratory disease, n (%) | 15 (20.3) | 5 (23.8) | 10 (18.9) | 0.75 |
Cirrhosis, n (%) | 1 (1.4) | 1 (4.8) | 0 (0) | 0.28 |
Trauma, n (%) | 7 (9.5) | 5 (23.8) | 2 (3.8) | 0.017 |
Burn, n (%) | 3 (4.1) | 1 (4.8) | 2 (3.8) | 1 |
Previous antifungal therapy, n (%) | 30 (40.5) | 5 (23.8) | 25 (47.2) | 0.07 |
Number of predisposing factors | 0.003 | |||
0, n (%) | 13 (17.6) | 8 (38.1) | 5 (9.4) | |
1, n (%) | 21 (28.4) | 9 (42.9) | 12 (22.6) | |
≥ 2, n (%) | 31 (41.9) | 4 (19.0) | 27 (50.9) | |
Site of infection | ||||
Lungs, n (%) | 29 (39.2) | 8 (38.1) | 21 (39.6) | 1 |
Skin, n (%) | 15 (20.3) | 7 (33.3) | 8 (15.1) | 0.11 |
Sinus and ENT infection, n (%) | 1 (1.35) | 1 (4.8) | 0 (0) | 0.28 |
Abdomen, n (%) | 1 (1.35) | 0 (0) | 1 (1.9) | 1 |
Bones, n (%) | 1 (1.35) | 1 (4.8) | 0 (0) | 0.28 |
Infection of contiguous sites, n (%) | 13 (17.6) | 4 (19.0) | 9 (17.0) | 1 |
Disseminated infection, n (%) | 14 (18.9) | 0 (0) | 14 (26.4) | 0.007 |
Isolated fungi | 0.04 | |||
Rhizopus genus, n (%) | 22 (29.7) | 2 (9.5) | 19 (35.8) | |
R. oryzae, n (%) | 5 (6.8) | |||
R. arrhizus, n (%) | 2 (2.7) | |||
R. microspores, n (%) | 1 (1.4) | |||
Rhizopus sp., n (%) | 14 (18.9) | |||
Mucor genus, n (%) | 10 (13.5) | 5 (23.8) | 5 (9.4) | |
M. circinelloides, n (%) | 3 (4.1) | |||
Mucor sp., n (%) | 7 (9.6) | |||
Rhizomucor genus, n (%) | 14 (18.9) | 2 (9.5) | 12 (22.6) | |
R. pusillus, n (%) | 3 (4.1) | |||
R. miehei, n (%) | 1 (1.4) | |||
Rhizomucor sp., n (%) | 10 (13.5) | |||
Lichtheimia genus, n (%) | 19 (25.7) | 8 (38.1) | 11 (20.8) | |
L. corymbifera, n (%) | 14 (18.9) | |||
Lichtheimia sp., n (%) | 5 (6.8) | |||
Cunninghamella genus, n (%) | 1 (1.4) | 0 (0) | 1 (1.9) | |
C. bertholletiae, n (%) | 1 (1.4) | |||
Unclassified mucorales, n (%) | 9 (12.2) | 4 (19.0) | 5 (9.4) | |
Severity of infection | ||||
SAPS2, mean (SD) a | 52 (22) | 36 (18) | 59 (19) | < 0.001 |
SOFA, mean (SD) a | 9 (4) | 6 (3) | 10 (4) | < 0.001 |
Respiratory | 2.0 (1.2) | 1.3 (1.3) | 2.2 (1.1) | 0.02 |
Cardiovascular | 1.7 (1.8) | 1.0 (1.4) | 2.0 (1.8) | 0.01 |
Renal | 1.1 (1.2) | 0.7 (1.0) | 1.3 (1.3) | 0.04 |
Hematological | 2.0 (1.4) | 1.0 (1.2) | 2.4 (1.3) | < 0.001 |
Neurological | 1.2 (1.5) | 0.9 (1.4) | 1.3 (1.5) | 0.35 |
Liver | 0.8 (0.9) | 0.6 (0.9) | 0.9 (0.9) | 0.24 |
Characteristics of the infection
Survival analysis
Number of patients (%) | Survivors (n = 21) | Non-survivors (n = 53) | P-value | |
---|---|---|---|---|
Type of ICU | 0.11 | |||
Medical, n (%) | 53 (71.6) | 13 (61.9) | 40 (75.5) | |
Surgical, n (%) | 13 (17.6) | 3 (14.3) | 10 (18.9) | |
Polyvalent, n (%) | 8 (10.8) | 5 (23.8) | 3 (5.7) | |
Year of admission | 0.70 | |||
Antifungal treatment | ||||
Treatment including L-AmB | 56 (75.7) | 19 (90.5) | 37 (69.8) | 0.08 |
L-AmB alone, n (%) | 44 (59.5) | 14 (66.7) | 30 (56.6) | 0.60 |
Association of L-AmB + other drug, n (%) | 12 (16.2) | 5 (23.8) | 7 (13.2) | 0.30 |
Triazole drug alone, n (%) | 4 (5.4) | 1 (4.8) | 3 (5.7) | 1 |
Echinocandine alone, n (%) | 1 (1.4) | 0 (0) | 1 (1.9) | 1 |
None, n (%) | 13 (17.6) | 1 (4.8) | 12 (22.6) | 0.09 |
Delay of efficient antifungal treatment, mean (SD)a | 9.5 (9.9) | 8.2 (7.6) | 10.1 (11.3) | 0.45 |
Interventions | ||||
Surgical intervention, n (%) | 27 (36.5) | 12 (57.1) | 15 (28.3) | 0.03 |
Cutaneous resection | 11 (14.9) | 3 (14.3) | 8 (15.1) | 1 |
Lung resection | 7 (9.5) | 6 (28.6) | 1 (1.9) | 0.002 |
Amputation | 2 (2.7) | 2 (9.5) | 0 | 0.08 |
ENT resection | 4 (5.4) | 1 (4.8) | 3 (5.7) | 1 |
Abdominal resection | 3 (4.1) | 0 | 3 (5.7) | 0.55 |
Vasopressors, n (%) | 53 (71.6) | 9 (42.9) | 44 (83.0) | 0.001 |
Mechanical ventilation, n (%) | 66 (89.2) | 14 (66.7) | 52 (98.1) | < 0.001 |
Renal replacement therapy, n (%) | 31 (41.9) | 5 (23.8) | 26 (49.1) | 0.07 |
Study population (n = 74) | Surgery (n = 27) | No surgery (n = 47) | P-value | |
---|---|---|---|---|
Age, years, mean (SD)a | 50.6 (16.6) | 49.2 (19.6) | 51.5 (14.8) | 0.60 |
Sex-ratio (H/F) | 1.96 | 1.1 | 2.92 | 0.08 |
Underlying disease | ||||
Hematological malignancies, n (%) | 41 (55.4) | 12 (44.4) | 29 (61.7) | 0.23 |
Acute myeloid leukemia, n (%) | 15 (20.3) | 5 (18.5) | 10 (21.3) | 1 |
Acute lymphoblastic leukemia, n (%) | 10 (13.5) | 3 (11.1) | 7 (14.9) | 0.74 |
Lymphoma, n (%) | 8 (10.8) | 3 (11.1) | 5 (10.6) | 1 |
Multiple myeloma, n (%) | 2 (2.7) | 0 | 2 (4.3) | 0.53 |
Myelodysplastic syndrome, n (%) | 2 (2.7) | 0 | 2 (4.3) | 0.53 |
Other, n (%) | 4 (5.4) | 1 (3.7) | 3 (6.4) | 1 |
Allogenic HSCT, n (%) | 16 (21.6) | 3 (11.1) | 13 (27.7) | 0.14 |
Autologous HSCT, n (%) | 7 (9.5) | 1 (3.7) | 6 (12.8) | 0.41 |
Solid malignancies, n (%) | 4 (5.4) | 1 (3.7) | 3 (6.4) | 1 |
SOT, n (%) | 9 (12.2) | 4 (14.8) | 5 (10.6) | 0.72 |
Inflammatory disease, n (%) | 2 (2.7) | 1 (3.7) | 1 (2.1) | 1 |
Systemic steroids, n (%) | 30 (40.5) | 8 (29.6) | 22 (46.8) | 0.15 |
Diabetes, n (%) | 11 (14.9) | 1 (3.7) | 10 (21.3) | 0.05 |
Other condition, n (%) | ||||
Chronic alcoholism, n (%) | 8 (10.8) | 3 (11.1) | 5 (10.6) | 1 |
Malnutrition, n (%) | 24 (32.4) | 10 (37.0) | 14 (29.8) | 0.70 |
Drug addiction, n (%) | 1 (1.4) | 0 | 1 (2.1) | 1 |
Chronic renal failure, n (%) | 7 (9.5) | 3 (11.1) | 4 (8.5) | 1 |
Respiratory disease, n (%) | 15 (20.3) | 2 (7.4) | 13 (27.7) | 0.13 |
Cirrhosis, n (%) | 1 (1.4) | 0 | 1 (2.1) | 1 |
Trauma, n (%) | 7 (9.5) | 2 (7.4) | 5 (10.6) | 1 |
Burn, n (%) | 3 (4.1) | 2 (7.4) | 1 (2.1) | 0.55 |
Previous antifungal therapy, n (%) | 30 (40.5) | 7 (25.9) | 23 (48.9) | 0.09 |
Site of infection | ||||
Lungs, n (%) | 29 (39.2) | 5 (18.5) | 24 (51.1) | 0.01 |
Skin, n (%) | 15 (20.3) | 8 (29.6) | 7 (14.9) | 0.22 |
Sinus and ENT infection, n (%) | 1 (1.35) | 1 (1.4) | 0 | 0.36 |
Abdomen, n (%) | 1 (1.35) | 1 (1.4) | 0 | 0.36 |
Bones, n (%) | 1 (1.35) | 0 | 1 (2.1) | 1 |
Infection of contiguous sites, n (%) | 13 (17.6) | 7 (25.9) | 6 (12.8) | 0.26 |
Disseminated infection, n (%) | 14 (18.9) | 4 (14.8) | 10 (21.3) | 0.55 |
Isolated fungi | 0.02 | |||
Rhizopus genus, n (%) | 22 (29.7) | 7 (25.9) | 15 (31.9) | |
Mucor genus, n (%) | 10 (13.5) | 2 (7.4) | 8 (17.0) | |
Rhizomucor genus, n (%) | 14 (18.9) | 4 (14.8) | 10 (21.3) | |
Lichtheimia genus, n (%) | 19 (25.7) | 7 (25.9) | 12 (25.5) | |
Cunninghamella genus, n (%) | 1 (1.4) | 0 | 1 (2.1) | |
Unclassified mucorales, n (%) | 9 (12.2) | 8 (29.6) | 1 (2.1) | |
Year of admission | 0.53 | |||
Severity of infection | ||||
SAPS2, mean (SD)a | 52 (22) | 44.6 (17.5) | 56.6 (22.5) | 0.01 |
SOFA, mean (SD)a | 9 (4) | 7.0 (3.3) | 9.9 (3.7) | 0.001 |
Respiratory | 2.0 (1.2) | 1.5 (1.3) | 2.2 (1.1) | 0.01 |
Cardiovascular | 1.7 (1.8) | 1.4 (1.6) | 1.9 (1.8) | 0.18 |
Renal | 1.1 (1.2) | 1.2 (1.2) | 1.1 (1.2) | 0.63 |
Hematological | 2.0 (1.4) | 1.4 (1.2) | 2.3 (1.5) | 0.006 |
Neurological | 1.2 (1.5) | 0.8 (1.3) | 1.4 (1.6) | 0.08 |
Liver | 0.8 (0.9) | 0.6 (0.8) | 0.9 (0.9) | 0.17 |
Biological abnormalities | ||||
TP < 50%, n (%) | 13 (17.6) | 2 (7.41) | 11 (23.4) | 0.12 |
Thrombocytes < 50G/L, n (%) | 27 (36.5) | 5 (18.5) | 22 (46.8) | 0.02 |
Leucocytes < 1G/L, n (%) | 23 (31.1) | 6 (22.2) | 17 (36.2) | 0.32 |
Interventions | ||||
Vasopressors | 53 (71.6) | 18 (66.7) | 35 (74.5) | 0.65 |
Mechanical ventilation | 66 (89.2) | 21 (77.8) | 45 (95.7) | 0.05 |
Renal replacement therapy | 31 (41.9) | 14 (51.9) | 17 (36.2) | 0.23 |
Delay of efficient antifungal treatment, mean (SD)a | 9.5 (9.9) | 10.2 (8.7) | 8.9 (11.2) | 0.64 |
Patients with hematological malignancies
Patients with hematological malignancies (n = 41) | Patients who survived (n = 7) | Patients who did not survived (n = 34) | P-value | |
---|---|---|---|---|
Age, mean (SD)a | 48.4 (15.0) | 34.7 (16.3) | 51.3 (13.3) | 0.04 |
Sex-ratio | 2.4 | 1.3 | 2.8 | 0.40 |
Malnutrition, n (%) | 14 (34.1) | 1 (14.3) | 13 (38.2) | 0.39 |
Diabetes, n (%) | 7 (17.1) | 0 (0) | 7 (20.6) | 0.32 |
Graft-versus-host disease, n (%) | 12 (29.3) | 1 (14.3) | 11 (32.4) | 0.65 |
Previous antifungal therapy, n (%) | 24 (58.5) | 0 (0) | 24 (70.6) | < 0.001 |
Site of infection | ||||
Lungs, n (%) | 19 (48.8) | 4 (57.1) | 16 (47.1) | 0.70 |
Skin, n (%) | 3 (7.3) | 1 (14.3) | 2 (5.9) | 0.44 |
Sinus and ENT infection, n (%) | 1 (2.4) | 1 (14.3) | 0 (0) | 0.17 |
Abdomen, n (%) | 1 (2.4) | 0 (0) | 1 (2.9) | 1 |
Bones, n (%) | 0 (0) | 0 (0) | 0 (0) | 1 |
Contiguous infection of > 1 organ, n (%) | 6 (14.6) | 1 (14.3) | 5 (14.7) | 1 |
Disseminated infection, n (%) | 10 (24.4) | 0 (0) | 10 (29.4) | 0.16 |
Isolated fungi | 0.19 | |||
Rhizopus sp., n (%) | 15 (36.6) | 1 (14.3) | 14 (41.2) | |
Mucor sp., n (%) | 2 (4.9) | 0 (0) | 2 (5.9) | |
Rhizomucor sp., n (%) | 11 (26.8) | 2 (28.6) | 9 (26.5) | |
Lichtheimia sp., n (%) | 7 (17.1) | 1 (14.3) | 6 (17.6) | |
Cunninghamella sp., n (%) | 1 (2.4) | 0 (0) | 1 (2.9) | |
Not identified zygomycetes, n (%) | 5 (12.2) | 3 (42.9) | 2 (5.9) | |
Severity of infection | ||||
SAPS2, mean (SD)a | 55.3 (21.0) | 31.4 (22.4) | 60.3 (21.0) | < 0.001 |
SOFA, mean (SD)a | 9.2 (4.2) | 4.0 (4.5) | 10.1 (4.3) | 0.002 |
Respiratory | 2.0 (1.1) | 0.9 (0.9) | 2.3 (1.0) | 0.005 |
Cardiovascular | 1.3 (1.8) | 0.2 (0.4) | 1.5 (1.8) | < 0.001 |
Renal | 0.9 (1.1) | 0.7 (1.0) | 0.9 (1.1) | 0.61 |
Hematological | 2.8 (1.2) | 1.5 (1.6) | 3.1 (1.0) | 0.07 |
Neurological | 1.0 (1.4) | 0.1 (0.4) | 1.2 (1.5) | 0.001 |
Liver | 1.0 (0.9) | 0.7 (0.8) | 1.1 (1.0) | 0.29 |
Biological abnormalities | ||||
TP < 50%, n (%) | 7 (17.1) | 0 (0) | 7 (20.6) | 0.32 |
Thrombocytes < 50G/L, n (%) | 24 (58.5) | 2 (28.6) | 22 (64.7) | 0.11 |
Leucocytes < 1G/L, n (%) | 21 (51.2%) | 1 (14.3) | 20 (58.8) | 0.04 |
Interventions | ||||
Surgical intervention, n (%) | 12 (29.3) | 6 (85.7) | 6 (17.6) | 0.001 |
Cutaneous resection | 2 (4.9) | 0 | 2 (5.9) | 1 |
Lung resection | 5 (12.2) | 5 (71.4) | 0 | < 0.001 |
ENT resection | 3 (7.3) | 1 (14.3) | 2 (5.9) | 0.44 |
Abdominal resection | 2 (4.9) | 0 | 2 (5.9) | 1 |
Vasopressors, n (%) | 27 (65.9) | 0 (0) | 27 (79.4) | < 0.001 |
Mechanical ventilation, n (%) | 35 (85.4) | 1 (14.3) | 34 (100) | <0.001 |
Renal replacement, n (%)therapy | 12 (29.3) | 0 (0) | 12 (35.3) | 0.08 |