1. Clinical Characteristics, Prognosis Factors and Metagenomic Next-Generation Sequencing Diagnosis of Mucormycosis in patients With Hematologic Diseases.
- Author
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Wang, Jieru, Liu, Li, Li, Jia, Feng, Xiaomeng, Yi, Huiming, Jiang, Erlie, Zheng, Yizhou, Zhang, Fengkui, Zhu, Xiaofan, Mi, Yingchang, Han, Mingzhe, Wang, Jianxiang, and Feng, Sizhou
- Abstract
Introduction: New diagnostic methods and antifungal strategies may improve prognosis of mucormycosis. We describe the diagnostic value of metagenomic next⁃generation sequencing (mNGS) and identify the prognostic factors of mucormycosis. 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. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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