Stability in the cumulative incidence, severity and mortality of 101 cases of invasive mucormycosis in high-risk patients from 1995 to 2011: A comparison of eras immediately before and after the availability of voriconazole and echinocandin-amphotericin combination therapies

Maheen Z. Abidi, Muhammad R. Sohail, Nathan W Cummins, Mark Wilhelm, Nancy Wengenack, Lisa Brumble, Harshal Shah, Donna Jane Hata, Ann Mccullough, Amy Wendel, Holenarasipur R. Vikram, Shimon Kusne, Mark R Litzow, Louis Letendre, Brian D. Lahr, Eric Poeschla, Randall C. Walker

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Summary: As invasive mucormycosis (IM) numbers rise, clinicians suspect prior voriconazole worsens IM incidence and severity, and believe combination anti-fungal therapy improves IM survival. To compare the cumulative incidence (CI), severity and mortality of IM in eras immediately before and after the commercial availability of voriconazole all IM cases from 1995 to 2011 were analysed across four risk-groups (hematologic/oncologic malignancy (H/O), stem cell transplantation (SCT), solid organ transplantation (SOT) and other), and two eras, E1 (1995-2003) and E2, (2004-2011). Of 101 IM cases, (79 proven, 22 probable): 30 were in E1 (3.3/year) and 71 in E2 (8.9/year). Between eras, the proportion with H/O or SCT rose from 47% to 73%, while 'other' dropped from 33% to 11% (P = 0.036). Between eras, the CI of IM did not significantly increase in SCT (P = 0.27) or SOT (P = 0.30), and patterns of anatomic location (P = 0.122) and surgical debridement (P = 0.200) were similar. Significantly more patients received amphotericin-echinocandin combination therapy in E2 (31% vs. 5%, P = 0.01); however, 90-day survival did not improve (54% vs. 59%, P = 0.67). Since 2003, the rise of IM reflects increasing numbers at risk, not prior use of voriconazole. Frequent combination of anti-fungal therapy has not improved survival.

Original languageEnglish (US)
Pages (from-to)687-698
Number of pages12
JournalMycoses
Volume57
Issue number11
DOIs
StatePublished - Nov 1 2014

Fingerprint

Echinocandins
Mucormycosis
Amphotericin B
Mortality
Incidence
Stem Cell Transplantation
Organ Transplantation
Hematologic Neoplasms
Therapeutics
Survival
Voriconazole
Debridement

Keywords

  • Amphotericin B
  • Combination therapy
  • Echinocandins
  • Invasive filamentous fungal infections
  • Mucormycosis
  • Outcome

ASJC Scopus subject areas

  • Dermatology
  • Infectious Diseases

Cite this

Stability in the cumulative incidence, severity and mortality of 101 cases of invasive mucormycosis in high-risk patients from 1995 to 2011 : A comparison of eras immediately before and after the availability of voriconazole and echinocandin-amphotericin combination therapies. / Abidi, Maheen Z.; Sohail, Muhammad R.; Cummins, Nathan W; Wilhelm, Mark; Wengenack, Nancy; Brumble, Lisa; Shah, Harshal; Jane Hata, Donna; Mccullough, Ann; Wendel, Amy; Vikram, Holenarasipur R.; Kusne, Shimon; Litzow, Mark R; Letendre, Louis; Lahr, Brian D.; Poeschla, Eric; Walker, Randall C.

In: Mycoses, Vol. 57, No. 11, 01.11.2014, p. 687-698.

Research output: Contribution to journalArticle

Abidi, Maheen Z. ; Sohail, Muhammad R. ; Cummins, Nathan W ; Wilhelm, Mark ; Wengenack, Nancy ; Brumble, Lisa ; Shah, Harshal ; Jane Hata, Donna ; Mccullough, Ann ; Wendel, Amy ; Vikram, Holenarasipur R. ; Kusne, Shimon ; Litzow, Mark R ; Letendre, Louis ; Lahr, Brian D. ; Poeschla, Eric ; Walker, Randall C. / Stability in the cumulative incidence, severity and mortality of 101 cases of invasive mucormycosis in high-risk patients from 1995 to 2011 : A comparison of eras immediately before and after the availability of voriconazole and echinocandin-amphotericin combination therapies. In: Mycoses. 2014 ; Vol. 57, No. 11. pp. 687-698.
@article{18504fbc673d43dc9a21ba8d2a72e6fd,
title = "Stability in the cumulative incidence, severity and mortality of 101 cases of invasive mucormycosis in high-risk patients from 1995 to 2011: A comparison of eras immediately before and after the availability of voriconazole and echinocandin-amphotericin combination therapies",
abstract = "Summary: As invasive mucormycosis (IM) numbers rise, clinicians suspect prior voriconazole worsens IM incidence and severity, and believe combination anti-fungal therapy improves IM survival. To compare the cumulative incidence (CI), severity and mortality of IM in eras immediately before and after the commercial availability of voriconazole all IM cases from 1995 to 2011 were analysed across four risk-groups (hematologic/oncologic malignancy (H/O), stem cell transplantation (SCT), solid organ transplantation (SOT) and other), and two eras, E1 (1995-2003) and E2, (2004-2011). Of 101 IM cases, (79 proven, 22 probable): 30 were in E1 (3.3/year) and 71 in E2 (8.9/year). Between eras, the proportion with H/O or SCT rose from 47{\%} to 73{\%}, while 'other' dropped from 33{\%} to 11{\%} (P = 0.036). Between eras, the CI of IM did not significantly increase in SCT (P = 0.27) or SOT (P = 0.30), and patterns of anatomic location (P = 0.122) and surgical debridement (P = 0.200) were similar. Significantly more patients received amphotericin-echinocandin combination therapy in E2 (31{\%} vs. 5{\%}, P = 0.01); however, 90-day survival did not improve (54{\%} vs. 59{\%}, P = 0.67). Since 2003, the rise of IM reflects increasing numbers at risk, not prior use of voriconazole. Frequent combination of anti-fungal therapy has not improved survival.",
keywords = "Amphotericin B, Combination therapy, Echinocandins, Invasive filamentous fungal infections, Mucormycosis, Outcome",
author = "Abidi, {Maheen Z.} and Sohail, {Muhammad R.} and Cummins, {Nathan W} and Mark Wilhelm and Nancy Wengenack and Lisa Brumble and Harshal Shah and {Jane Hata}, Donna and Ann Mccullough and Amy Wendel and Vikram, {Holenarasipur R.} and Shimon Kusne and Litzow, {Mark R} and Louis Letendre and Lahr, {Brian D.} and Eric Poeschla and Walker, {Randall C.}",
year = "2014",
month = "11",
day = "1",
doi = "10.1111/myc.12222",
language = "English (US)",
volume = "57",
pages = "687--698",
journal = "Mycoses",
issn = "0933-7407",
publisher = "Wiley-Blackwell",
number = "11",

}

TY - JOUR

T1 - Stability in the cumulative incidence, severity and mortality of 101 cases of invasive mucormycosis in high-risk patients from 1995 to 2011

T2 - A comparison of eras immediately before and after the availability of voriconazole and echinocandin-amphotericin combination therapies

AU - Abidi, Maheen Z.

AU - Sohail, Muhammad R.

AU - Cummins, Nathan W

AU - Wilhelm, Mark

AU - Wengenack, Nancy

AU - Brumble, Lisa

AU - Shah, Harshal

AU - Jane Hata, Donna

AU - Mccullough, Ann

AU - Wendel, Amy

AU - Vikram, Holenarasipur R.

AU - Kusne, Shimon

AU - Litzow, Mark R

AU - Letendre, Louis

AU - Lahr, Brian D.

AU - Poeschla, Eric

AU - Walker, Randall C.

PY - 2014/11/1

Y1 - 2014/11/1

N2 - Summary: As invasive mucormycosis (IM) numbers rise, clinicians suspect prior voriconazole worsens IM incidence and severity, and believe combination anti-fungal therapy improves IM survival. To compare the cumulative incidence (CI), severity and mortality of IM in eras immediately before and after the commercial availability of voriconazole all IM cases from 1995 to 2011 were analysed across four risk-groups (hematologic/oncologic malignancy (H/O), stem cell transplantation (SCT), solid organ transplantation (SOT) and other), and two eras, E1 (1995-2003) and E2, (2004-2011). Of 101 IM cases, (79 proven, 22 probable): 30 were in E1 (3.3/year) and 71 in E2 (8.9/year). Between eras, the proportion with H/O or SCT rose from 47% to 73%, while 'other' dropped from 33% to 11% (P = 0.036). Between eras, the CI of IM did not significantly increase in SCT (P = 0.27) or SOT (P = 0.30), and patterns of anatomic location (P = 0.122) and surgical debridement (P = 0.200) were similar. Significantly more patients received amphotericin-echinocandin combination therapy in E2 (31% vs. 5%, P = 0.01); however, 90-day survival did not improve (54% vs. 59%, P = 0.67). Since 2003, the rise of IM reflects increasing numbers at risk, not prior use of voriconazole. Frequent combination of anti-fungal therapy has not improved survival.

AB - Summary: As invasive mucormycosis (IM) numbers rise, clinicians suspect prior voriconazole worsens IM incidence and severity, and believe combination anti-fungal therapy improves IM survival. To compare the cumulative incidence (CI), severity and mortality of IM in eras immediately before and after the commercial availability of voriconazole all IM cases from 1995 to 2011 were analysed across four risk-groups (hematologic/oncologic malignancy (H/O), stem cell transplantation (SCT), solid organ transplantation (SOT) and other), and two eras, E1 (1995-2003) and E2, (2004-2011). Of 101 IM cases, (79 proven, 22 probable): 30 were in E1 (3.3/year) and 71 in E2 (8.9/year). Between eras, the proportion with H/O or SCT rose from 47% to 73%, while 'other' dropped from 33% to 11% (P = 0.036). Between eras, the CI of IM did not significantly increase in SCT (P = 0.27) or SOT (P = 0.30), and patterns of anatomic location (P = 0.122) and surgical debridement (P = 0.200) were similar. Significantly more patients received amphotericin-echinocandin combination therapy in E2 (31% vs. 5%, P = 0.01); however, 90-day survival did not improve (54% vs. 59%, P = 0.67). Since 2003, the rise of IM reflects increasing numbers at risk, not prior use of voriconazole. Frequent combination of anti-fungal therapy has not improved survival.

KW - Amphotericin B

KW - Combination therapy

KW - Echinocandins

KW - Invasive filamentous fungal infections

KW - Mucormycosis

KW - Outcome

UR - http://www.scopus.com/inward/record.url?scp=84907948764&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84907948764&partnerID=8YFLogxK

U2 - 10.1111/myc.12222

DO - 10.1111/myc.12222

M3 - Article

C2 - 25040241

AN - SCOPUS:84907948764

VL - 57

SP - 687

EP - 698

JO - Mycoses

JF - Mycoses

SN - 0933-7407

IS - 11

ER -