title: Mucormycosis in Australia: contemporary epidemiology and outcomes.
abstract: Mucormycosis is the second most common cause of invasive mould infection and causes disease in diverse hosts, including those who are immuno-competent. We conducted a multicentre retrospective study of proven and probable cases of mucormycosis diagnosed between 2004-2012 to determine the epidemiology and outcome determinants in Australia. Seventy-four cases were identified (63 proven, 11 probable). The majority (54.1%) were caused by Rhizopus spp. Patients who sustained trauma were more likely to have non-Rhizopus infections relative to patients without trauma (OR 9.0, p 0.001, 95% CI 2.1-42.8). Haematological malignancy (48.6%), chemotherapy (42.9%), corticosteroids (52.7%), diabetes mellitus (27%) and trauma (22.9%) were the most common co-morbidities or risk factors. Rheumatological/autoimmune disorders occurred in nine (12.1%) instances. Eight (10.8%) cases had no underlying co-morbidity and were more likely to have associated trauma (7/8; 87.5% versus 10/66; 15.2%; p <0.001). Disseminated infection was common (39.2%). Apophysomyces spp. and Saksenaea spp. caused infection in immuno-competent hosts, most frequently associated with trauma and affected sites other than lung and sinuses. The 180-day mortality was 56.7%. The strongest predictors of mortality were rheumatological/autoimmune disorder (OR = 24.0, p 0.038 95% CI 1.2-481.4), haematological malignancy (OR = 7.7, p 0.001, 95% CI 2.3-25.2) and admission to intensive care unit (OR = 4.2, p 0.02, 95% CI 1.3-13.8). Most deaths occurred within one month. Thereafter we observed divergence in survival between the haematological and non-haematological populations (p 0.006). The mortality of mucormycosis remains particularly high in the immuno-compromised host. Underlying rheumatological/autoimmune disorders are a previously under-appreciated risk for infection and poor outcome.
authors.affiliation: Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, Australia. Electronic address: Karina.kennedy@act.gov.au.
authors.forename: K J
authors.initials: KJ
authors.lastname: Kennedy
authors.affiliation: Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Daveson
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Infectious Diseases Service at the Doherty Institute for Infection and Immunity, Melbourne, Australia.
authors.forename: M A
authors.initials: MA
authors.lastname: Slavin
authors.affiliation: Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: S J
authors.initials: SJ
authors.lastname: van Hal
authors.affiliation: Centre for Infectious Diseases and Microbiology, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia.
authors.forename: T C
authors.initials: TC
authors.lastname: Sorrell
authors.affiliation: Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Lee
authors.affiliation: Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, Australia.
authors.forename: D J
authors.initials: DJ
authors.lastname: Marriott
authors.affiliation: The Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia; Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Sydney, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Chapman
authors.affiliation: Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Sydney, Australia.
authors.forename: C L
authors.initials: CL
authors.lastname: Halliday
authors.affiliation: Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Hajkowicz
authors.affiliation: Department of Infectious Diseases, Barwon Health, Deakin University, Geelong, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Athan
authors.affiliation: Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Bak
authors.affiliation: Department of Infectious Diseases and Microbiology, Concord Hospital, Sydney, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Cheong
authors.affiliation: Department of Microbiology and Infectious Diseases, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
authors.forename: C H
authors.initials: CH
authors.lastname: Heath
authors.affiliation: Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia.
authors.forename: C O
authors.initials: CO
authors.lastname: Morrissey
authors.affiliation: National Mycology Reference Centre, SA Pathology, Adelaide, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Kidd
authors.affiliation: Department of Infectious Diseases and Microbiology, Liverpool Hospital, Sydney, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Beresford
authors.affiliation: School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital, Perth, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Blyth
authors.affiliation: Monash Infectious Diseases and Monash University, Melbourne, Australia.
authors.forename: T M
authors.initials: TM
authors.lastname: Korman
authors.affiliation: Department of Microbiology and Infectious Diseases, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Australian Collaborating Centre for Enterococcus and Staphylococcus Species Typing and Research, School of Biomedical Sciences, Curtin University, School of Veterinary and Life Sciences, Murdoch University, Perth, Australia.
authors.forename: J O
authors.initials: JO
authors.lastname: Robinson
authors.affiliation: The Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia; Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Sydney, Australia.
authors.forename: W
authors.initials: W
authors.lastname: Meyer
authors.affiliation: Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Sydney, Australia; Centre for Infectious Diseases and Microbiology, The University of Sydney, Sydney, Australia.
authors.forename: S C-A
authors.initials: SC
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D019468:Disease Management; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D063868:Patient Outcome Assessment; D012189:Retrospective Studies; D055815:Young Adult
keywords: Apophysomyces; Mucorales; Rhizopus; Saksenaea; epidemiology; mortality; mucormycete; mucormycosis; zygomycosis