Mucormycosis in intensive care unit: surgery ...
Document type :
Article dans une revue scientifique
Permalink :
Title :
Mucormycosis in intensive care unit: surgery is a major prognostic factor in patients with hematological malignancy
Author(s) :
Claustre, Johanna [Auteur]
Centre de Recherche en Transplantation et Immunologie [U1064 Inserm - CRTI]
Larcher, Romaric [Auteur]
CHU Montpellier
Jouve, Thomas [Auteur]
Centre Hospitalier Universitaire [CHU Grenoble] [CHUGA]
Service de néphrologie, dialyse, aphérèses et transplantation
Truche, Anne-Sophie [Auteur]
Service de Réanimation Médicale [Grenoble]
Nseir, Saad [Auteur]
Unité de Glycobiologie Structurale et Fonctionnelle (UGSF) - UMR 8576
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Cadiet, Julien [Auteur]
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital [CHU Nantes]
Zerbib, Yoann [Auteur]
CHU Amiens-Picardie
Lautrette, Alexandre [Auteur]
CHU Clermont-Ferrand
Constantin, Jean-Michel [Auteur]
CHU Clermont-Ferrand
Charles, Pierre-Emmanuel [Auteur]
Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand [CHU Dijon]
Daubin, Cedric [Auteur]
Service de réanimation médicale [CHU Caen]
Coudroy, Remi [Auteur]
Centre hospitalier universitaire de Poitiers = Poitiers University Hospital [CHU de Poitiers [La Milétrie]]
Dellamonica, Jean [Auteur]
CHU Nice [Cimiez]
Argaud, Laurent [Auteur]
CIC CHU Lyon (inserm)
Phelouzat, Pierre [Auteur]
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
Contou, Damien [Auteur]
Service de réanimation médicale
Pocquet, Juliette [Auteur]
CHU Trousseau [Tours]
Voiriot, Guillaume [Auteur]
Navellou, Jean-Christophe [Auteur]
Lavagne, Pierre [Auteur]
Centre Hospitalier Universitaire [CHU Grenoble] [CHUGA]
Durand, Michel [Auteur]
Centre Hospitalier Universitaire [CHU Grenoble] [CHUGA]
Service de réanimation cardio-vasculaire et thoracique
Cornet, Muriel [Auteur]
Laboratoire de parasitologie-mycologie
Schwebel, Carole [Auteur]
Service de Réanimation Médicale [Grenoble]
Terzi, Nicolas [Auteur]
Service de Réanimation Médicale [Grenoble]
Centre de Recherche en Transplantation et Immunologie [U1064 Inserm - CRTI]
Larcher, Romaric [Auteur]
CHU Montpellier
Jouve, Thomas [Auteur]
Centre Hospitalier Universitaire [CHU Grenoble] [CHUGA]
Service de néphrologie, dialyse, aphérèses et transplantation
Truche, Anne-Sophie [Auteur]
Service de Réanimation Médicale [Grenoble]
Nseir, Saad [Auteur]
Unité de Glycobiologie Structurale et Fonctionnelle (UGSF) - UMR 8576
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Cadiet, Julien [Auteur]
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital [CHU Nantes]
Zerbib, Yoann [Auteur]
CHU Amiens-Picardie
Lautrette, Alexandre [Auteur]
CHU Clermont-Ferrand
Constantin, Jean-Michel [Auteur]
CHU Clermont-Ferrand
Charles, Pierre-Emmanuel [Auteur]
Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand [CHU Dijon]
Daubin, Cedric [Auteur]
Service de réanimation médicale [CHU Caen]
Coudroy, Remi [Auteur]
Centre hospitalier universitaire de Poitiers = Poitiers University Hospital [CHU de Poitiers [La Milétrie]]
Dellamonica, Jean [Auteur]
CHU Nice [Cimiez]
Argaud, Laurent [Auteur]
CIC CHU Lyon (inserm)
Phelouzat, Pierre [Auteur]
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
Contou, Damien [Auteur]
Service de réanimation médicale
Pocquet, Juliette [Auteur]
CHU Trousseau [Tours]
Voiriot, Guillaume [Auteur]
Navellou, Jean-Christophe [Auteur]
Lavagne, Pierre [Auteur]
Centre Hospitalier Universitaire [CHU Grenoble] [CHUGA]
Durand, Michel [Auteur]
Centre Hospitalier Universitaire [CHU Grenoble] [CHUGA]
Service de réanimation cardio-vasculaire et thoracique
Cornet, Muriel [Auteur]
Laboratoire de parasitologie-mycologie
Schwebel, Carole [Auteur]
Service de Réanimation Médicale [Grenoble]
Terzi, Nicolas [Auteur]
Service de Réanimation Médicale [Grenoble]
Journal title :
Annals of Intensive Care
Abbreviated title :
Ann. Intensive Care
Volume number :
10
Publisher :
Springer Science and Business Media LLC
Publication date :
2020-06-08
ISSN :
2110-5820
English keyword(s) :
Mucormycosis
Hematological malignancy
Intensive care unit
Surgery
Prognostic factors
Hematological malignancy
Intensive care unit
Surgery
Prognostic factors
HAL domain(s) :
Sciences du Vivant [q-bio]
English abstract : [en]
Background :
Mucormycosis is an invasive fungal infection, with an increasing incidence especially in patients with hematological malignancies. Its prognosis is poor because of its high invasive power and its intrinsic ...
Show more >Background : Mucormycosis is an invasive fungal infection, with an increasing incidence especially in patients with hematological malignancies. Its prognosis is poor because of its high invasive power and its intrinsic low susceptibility to antifungal agents. We aimed to describe the epidemiology of mucormycosis in intensive care units (ICU) and evaluate the outcomes. We performed a retrospective multi-center study in 16 French ICUs between 2008 and 2017. We compared the patients who survived in ICU and the patients who did not to identify factors associated with ICU survival. Then, we focused on the subgroup of patients with hematological malignancies. Results : Mucormycosis was diagnosed in 74 patients during the study period. Among them, 60 patients (81%) were immunocompromised: 41 had hematological malignancies, 9 were solid organ transplant recipients, 31 received long-term steroids, 11 had diabetes, 24 had malnutrition. Only 21 patients survived to ICU stay (28.4%) with a median survival of 22 days (Q1–Q3 = 9–106) and a survival rate at day 28 and day 90, respectively, of 35.1% and 26.4%. Survivors were significantly younger (p = 0.001), with less frequently hematological malignancies (p = 0.02), and less malnutrition (p = 0.05). Median survival in patients with hematological malignancies (n = 41) was 15 days (Q1–Q3 = 5–23.5 days). In this subgroup, curative surgery was a major factor associated with survival in multivariate analysis (odds ratio = 0.71, [0.45–0.97], p < 0.001). Conclusion : Overall prognosis of mucormycosis in ICU remains poor, especially in patients with hematological malignancies. In this subgroup of patients, a therapeutic strategy including curative surgery was the main factor associated with survival.Show less >
Show more >Background : Mucormycosis is an invasive fungal infection, with an increasing incidence especially in patients with hematological malignancies. Its prognosis is poor because of its high invasive power and its intrinsic low susceptibility to antifungal agents. We aimed to describe the epidemiology of mucormycosis in intensive care units (ICU) and evaluate the outcomes. We performed a retrospective multi-center study in 16 French ICUs between 2008 and 2017. We compared the patients who survived in ICU and the patients who did not to identify factors associated with ICU survival. Then, we focused on the subgroup of patients with hematological malignancies. Results : Mucormycosis was diagnosed in 74 patients during the study period. Among them, 60 patients (81%) were immunocompromised: 41 had hematological malignancies, 9 were solid organ transplant recipients, 31 received long-term steroids, 11 had diabetes, 24 had malnutrition. Only 21 patients survived to ICU stay (28.4%) with a median survival of 22 days (Q1–Q3 = 9–106) and a survival rate at day 28 and day 90, respectively, of 35.1% and 26.4%. Survivors were significantly younger (p = 0.001), with less frequently hematological malignancies (p = 0.02), and less malnutrition (p = 0.05). Median survival in patients with hematological malignancies (n = 41) was 15 days (Q1–Q3 = 5–23.5 days). In this subgroup, curative surgery was a major factor associated with survival in multivariate analysis (odds ratio = 0.71, [0.45–0.97], p < 0.001). Conclusion : Overall prognosis of mucormycosis in ICU remains poor, especially in patients with hematological malignancies. In this subgroup of patients, a therapeutic strategy including curative surgery was the main factor associated with survival.Show less >
Language :
Anglais
Audience :
Internationale
Popular science :
Non
Administrative institution(s) :
Université de Lille
CNRS
CNRS
Research team(s) :
Glycobiology in fungal Pathogenesis and Clinical Applications
Submission date :
2021-07-15T09:11:24Z
2021-08-25T09:24:27Z
2021-08-25T09:24:27Z
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