A multicentre observational study on the epidemiology, risk factors, management and outcomes of mucormycosis in India

Objectives: To describe the epidemiology, management and outcome of individuals with mucormycosis; and to evaluate the risk factors associated with mortality. Methods: We conducted a prospective observational study involving consecutive individuals with proven mucormycosis across 12 centres from India. The demographic pro file, microbiology, predisposing factors, management and 90 -day mortality were recorded; risk factors for mortality were analysed. Results: We included 465 patients. Rhino -orbital mucormycosis was the most common (315/465, 67.7%) presentation followed by pulmonary (62/465, 13.3%), cutaneous (49/465, 10.5%), and others. The pre- disposing factors included diabetes mellitus (342/465, 73.5%), malignancy (42/465, 9.0%), transplant (36/ 465, 7.7%), and others. Rhizopus species (231/290, 79.7%) were the most common followed by Apophy- somyces variabilis (23/290, 7.9%), and several rare Mucorales . Surgical treatment was performed in 62.2% (289/465) of the participants. Amphotericin B was the primary therapy in 81.9% (381/465), and pos- aconazole was used as combination therapy in 53 (11.4%) individuals. Antifungal therapy was inappro- priate in 7.6% (30/394) of the individuals. The 90 -day mortality rate was 52% (242/465). On multivariate analysis, disseminated and rhino -orbital (with cerebral extension) mucormycosis, shorter duration of symptoms, shorter duration of antifungal therapy, and treatment with amphotericin B deoxycholate (versus liposomal) were independent risk factors of mortality. A combined medical and surgical man- agement was associated with a better survival. Conclusions: Diabetes mellitus was the dominant predisposing factor in all forms of mucormycosis. Combined surgical and medical management was associated with better outcomes. Several gaps surfaced in the management of mucormycosis. The rarer Mucorales identi fied in the study warrant further eval- uation. A. Patel, Clin Microbiol Infect 2020;26:944.e9 - 944.e15 ? 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.