Clinical Characteristics, Prognosis Factors and Metagenomic Next-Generation Sequencing Diagnosis of Mucormycosis in patients With Hematologic Diseases.
Humans
Mucormycosis
/ diagnosis
Male
Female
Retrospective Studies
Middle Aged
High-Throughput Nucleotide Sequencing
Prognosis
Antifungal Agents
/ therapeutic use
Adult
Aged
Hematologic Diseases
/ complications
Amphotericin B
/ therapeutic use
Metagenomics
/ methods
Triazoles
/ therapeutic use
Young Adult
Drug Therapy, Combination
Survival Analysis
Treatment Outcome
Antifungal therapy
Hematologic disease
Metagenomic next-generation sequencing
Mucormycosis
Prognosis factor
Journal
Mycopathologia
ISSN: 1573-0832
Titre abrégé: Mycopathologia
Pays: Netherlands
ID NLM: 7505689
Informations de publication
Date de publication:
01 Aug 2024
01 Aug 2024
Historique:
received:
06
06
2024
accepted:
02
07
2024
medline:
1
8
2024
pubmed:
1
8
2024
entrez:
1
8
2024
Statut:
epublish
Résumé
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. 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. 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. 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.
Identifiants
pubmed: 39088077
doi: 10.1007/s11046-024-00875-w
pii: 10.1007/s11046-024-00875-w
doi:
Substances chimiques
Antifungal Agents
0
Amphotericin B
7XU7A7DROE
posaconazole
6TK1G07BHZ
Triazoles
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
71Subventions
Organisme : Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences and Peking Union Medical College
ID : 2021-I2M-1-017
Organisme : Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences
ID : 2021-I2M-C&T-B-080
Organisme : Haihe Laboratory of Cell Ecosystem Innovation Fund
ID : 22HHXBSS00036
Organisme : Tianjin Municipal Science and Technology Commission Grant
ID : 21JCZDJC01170
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer Nature B.V.
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