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Introduction of a Comprehensive Diagnostic and Interdisciplinary Management Approach in Haematological Patients with Mucormycosis: A Pre and Post-Intervention Analysis

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Risum, Malene ; Helweg-Larsen, Jannik ; Petersen, Søren Lykke ; Kampmann, Peter ; Overgaard, Ulrik Malthe ; El Fassi, Daniel ; Nielsen, Ove Juul ; Brabrand, Mette ; Rubek, Niclas ; Munksgaard, Lars ; Severinsen, Marianne Tang ; Nielsen, Bendt ; Gertsen, Jan Berg ; Gylfe, Åsa ; Hjort, Ulla ; Vourtsi, Angeliki ; Hare, Rasmus Krøger ; Arendrup, Maiken Cavling. / Introduction of a Comprehensive Diagnostic and Interdisciplinary Management Approach in Haematological Patients with Mucormycosis : A Pre and Post-Intervention Analysis. I: Journal of fungi (Basel, Switzerland). 2020 ; Bind 6, Nr. 4. s. 1-16.

Bibtex

@article{210cf305a27e43b4aae6b1ba8510223a,
title = "Introduction of a Comprehensive Diagnostic and Interdisciplinary Management Approach in Haematological Patients with Mucormycosis: A Pre and Post-Intervention Analysis",
abstract = "Mucormycosis is a life threatening infection in patients with haematological disease. We introduced a Mucorales-PCR and an aggressive, multidisciplinary management approach for mucormycosis during 2016-2017 and evaluated patient outcomes in 13 patients diagnosed and treated in 2012-2019. Management principle: repeated surgical debridement until biopsies from the resection margins were clean as defined by negative Blankophor microscopy, Mucorales-PCR (both reported within 24 h), and cultures. Cultured isolates underwent EUCAST E.Def 9.3.1 susceptibility testing. Antifungal therapy (AFT) (mono/combination) combined with topical AFT (when possible) was given according to the minimal inhibitory concentration (MIC), severity of the infection, and for azoles, specifically, it was guided by therapeutic drug monitoring. The outcome was evaluated by case record review. All patients underwent surgery guided by diagnostic biopsies from tissue and resection margins (195 samples in total). Comparing 2012-2015 and 2016-2019, the median number of patients of surgical debridements was 3 and 2.5 and of diagnostic samples: microscopy/culture/PCR was 3/3/6 and 10.5/10/10.5, respectively. The sensitivity of microscopy (76%) and Mucorales-PCR (70%) were similar and microscopy was superior to that of culture (53%; p = 0.039). Initial systemic AFT was liposomal amphotericin B (n = 12) or posaconazole (n = 1) given as monotherapy (n = 4) or in combination with isavuconazole/posaconazole (n = 3/6) and terbinafine (n = 3). Nine patients received topical amphotericin B. All received isavuconazole or posaconazole consolidation therapy (n = 13). Mucormycosis related six month mortality was 3/5 in 2012-2015 and 0/7 patients in 2016-2019 (one patient was lost for follow-up). Implementation of combination therapy (systemic+topical AFT/combination systemic AFT) and aggressive surgical debridement guided by optimised diagnostic tests may improve the outcome of mucormycosis in haematologic patients.",
author = "Malene Risum and Jannik Helweg-Larsen and Petersen, {S{\o}ren Lykke} and Peter Kampmann and Overgaard, {Ulrik Malthe} and {El Fassi}, Daniel and Nielsen, {Ove Juul} and Mette Brabrand and Niclas Rubek and Lars Munksgaard and Severinsen, {Marianne Tang} and Bendt Nielsen and Gertsen, {Jan Berg} and {\AA}sa Gylfe and Ulla Hjort and Angeliki Vourtsi and Hare, {Rasmus Kr{\o}ger} and Arendrup, {Maiken Cavling}",
year = "2020",
month = nov,
day = "8",
doi = "10.3390/jof6040268",
language = "English",
volume = "6",
pages = "1--16",
journal = "Journal of Fungi",
issn = "2309-608X",
publisher = "MDPI AG",
number = "4",

}

RIS

TY - JOUR

T1 - Introduction of a Comprehensive Diagnostic and Interdisciplinary Management Approach in Haematological Patients with Mucormycosis

T2 - A Pre and Post-Intervention Analysis

AU - Risum, Malene

AU - Helweg-Larsen, Jannik

AU - Petersen, Søren Lykke

AU - Kampmann, Peter

AU - Overgaard, Ulrik Malthe

AU - El Fassi, Daniel

AU - Nielsen, Ove Juul

AU - Brabrand, Mette

AU - Rubek, Niclas

AU - Munksgaard, Lars

AU - Severinsen, Marianne Tang

AU - Nielsen, Bendt

AU - Gertsen, Jan Berg

AU - Gylfe, Åsa

AU - Hjort, Ulla

AU - Vourtsi, Angeliki

AU - Hare, Rasmus Krøger

AU - Arendrup, Maiken Cavling

PY - 2020/11/8

Y1 - 2020/11/8

N2 - Mucormycosis is a life threatening infection in patients with haematological disease. We introduced a Mucorales-PCR and an aggressive, multidisciplinary management approach for mucormycosis during 2016-2017 and evaluated patient outcomes in 13 patients diagnosed and treated in 2012-2019. Management principle: repeated surgical debridement until biopsies from the resection margins were clean as defined by negative Blankophor microscopy, Mucorales-PCR (both reported within 24 h), and cultures. Cultured isolates underwent EUCAST E.Def 9.3.1 susceptibility testing. Antifungal therapy (AFT) (mono/combination) combined with topical AFT (when possible) was given according to the minimal inhibitory concentration (MIC), severity of the infection, and for azoles, specifically, it was guided by therapeutic drug monitoring. The outcome was evaluated by case record review. All patients underwent surgery guided by diagnostic biopsies from tissue and resection margins (195 samples in total). Comparing 2012-2015 and 2016-2019, the median number of patients of surgical debridements was 3 and 2.5 and of diagnostic samples: microscopy/culture/PCR was 3/3/6 and 10.5/10/10.5, respectively. The sensitivity of microscopy (76%) and Mucorales-PCR (70%) were similar and microscopy was superior to that of culture (53%; p = 0.039). Initial systemic AFT was liposomal amphotericin B (n = 12) or posaconazole (n = 1) given as monotherapy (n = 4) or in combination with isavuconazole/posaconazole (n = 3/6) and terbinafine (n = 3). Nine patients received topical amphotericin B. All received isavuconazole or posaconazole consolidation therapy (n = 13). Mucormycosis related six month mortality was 3/5 in 2012-2015 and 0/7 patients in 2016-2019 (one patient was lost for follow-up). Implementation of combination therapy (systemic+topical AFT/combination systemic AFT) and aggressive surgical debridement guided by optimised diagnostic tests may improve the outcome of mucormycosis in haematologic patients.

AB - Mucormycosis is a life threatening infection in patients with haematological disease. We introduced a Mucorales-PCR and an aggressive, multidisciplinary management approach for mucormycosis during 2016-2017 and evaluated patient outcomes in 13 patients diagnosed and treated in 2012-2019. Management principle: repeated surgical debridement until biopsies from the resection margins were clean as defined by negative Blankophor microscopy, Mucorales-PCR (both reported within 24 h), and cultures. Cultured isolates underwent EUCAST E.Def 9.3.1 susceptibility testing. Antifungal therapy (AFT) (mono/combination) combined with topical AFT (when possible) was given according to the minimal inhibitory concentration (MIC), severity of the infection, and for azoles, specifically, it was guided by therapeutic drug monitoring. The outcome was evaluated by case record review. All patients underwent surgery guided by diagnostic biopsies from tissue and resection margins (195 samples in total). Comparing 2012-2015 and 2016-2019, the median number of patients of surgical debridements was 3 and 2.5 and of diagnostic samples: microscopy/culture/PCR was 3/3/6 and 10.5/10/10.5, respectively. The sensitivity of microscopy (76%) and Mucorales-PCR (70%) were similar and microscopy was superior to that of culture (53%; p = 0.039). Initial systemic AFT was liposomal amphotericin B (n = 12) or posaconazole (n = 1) given as monotherapy (n = 4) or in combination with isavuconazole/posaconazole (n = 3/6) and terbinafine (n = 3). Nine patients received topical amphotericin B. All received isavuconazole or posaconazole consolidation therapy (n = 13). Mucormycosis related six month mortality was 3/5 in 2012-2015 and 0/7 patients in 2016-2019 (one patient was lost for follow-up). Implementation of combination therapy (systemic+topical AFT/combination systemic AFT) and aggressive surgical debridement guided by optimised diagnostic tests may improve the outcome of mucormycosis in haematologic patients.

U2 - 10.3390/jof6040268

DO - 10.3390/jof6040268

M3 - Journal article

C2 - 33171634

VL - 6

SP - 1

EP - 16

JO - Journal of Fungi

JF - Journal of Fungi

SN - 2309-608X

IS - 4

ER -

ID: 62073838