Multicenter Case-Control Study of COVID-19-Associated Mucormycosis Outbreak, India

We performed a case-control study across 25 hospitals in India for the period of January-June 2021 to evaluate the reasons for an COVID-19-associated mucormycosis (CAM) outbreak. We investigated whether COVID-19 treat-ment practices (glucocorticoids, zinc, tocilizumab, and oth-ers) were associated with CAM. We included 1,733 cases of CAM and 3,911 age-matched COVID-19 controls. We found cumulative glucocorticoid dose (odds ratio [OR] 1.006, 95% CI 1.004-1.007) and zinc supplementation (OR 2.76, 95% CI 2.24-3.40), along with elevated C-reactive protein (OR 1.004, 95% CI 1.002-1.006), host factors (re-nal transplantation [OR 7.58, 95% CI 3.31-17.40], diabetes mellitus [OR 6.72, 95% CI 5.45-8.28], diabetic ketoacidosis during COVID-19 [OR 4.41, 95% CI 2.03-9.60]), and rural residence (OR 2.88, 95% CI 2.12-3.79), significantly as-sociated with CAM. Mortality rate at 12 weeks was 32.2% (473/1,471). We emphasize the judicious use of COVID-19 therapies and optimal glycemic control to prevent CAM.

Automated summary

We conducted a case-control study in 25 hospitals in India to investigate the causes of a COVID-19-associated mucormycosis outbreak. The study found that cumulative glucocorticoid dose, zinc supplementation, elevated C-reactive protein, host factors (renal transplantation, diabetes mellitus, diabetic ketoacidosis during COVID-19), and rural residence were significantly associated with CAM. The study emphasizes the importance of judicious use of COVID-19 therapies and optimal glycemic control to prevent CAM.