Zygomycosis in a Tertiary-Care Cancer Center in the Era of Aspergillus-Active Antifungal Therapy: A Case-Control Observational Study of 27 Recent Cases.

Background. Anecdotal evidence suggests a rise in zygomycosis in association with voriconazole (VRC) use in immunosuppressed patients. Methods. We performed prospective surveillance of patients with zygomycosis (group A; ) and compared np27 them with contemporaneous patients with invasive aspergillosis (group B; ) and with matched contempo- np54 raneous high-risk patients without fungal infection (group C; ). We also performed molecular typing and in np54 vitro susceptibility testing of Zygomycetes isolates. Results. Nearly all patients with zygomycosis either had leukemia ( ) or were allogeneic bone marrow np14 transplant recipients ( ). The Zygomycetes isolates (74% of which were of the genus Rhizopus) had different np13 molecular fingerprinting profiles, and all were VRC resistant. In multivariate analysis of groups A and C, VRC prophylaxis (odds ratio [OR], 10.37 [95% confidence interval {CI}], 2.76-38.97]; ), diabetes (OR, 8.39 Pp.001 [95% CI, 2.04-34.35]; ), and malnutrition (OR, 3.70 [95% CI, 1.03-13.27]; ) were found to be Pp.003 Pp.045 independent risk factors for zygomycosis. Between patients with zygomycosis (after excluding 6 patients with mixed mold infections) and patients with aspergillosis, VRC prophylaxis (OR, 20.30 [95% CI, 3.85-108.15]; ) Pp.0001 and sinusitis (OR, 76.72 [95% CI, 6.48-908.15]; ) were the only factors that favored the diagnosis of Pp.001 zygomycosis. Conclusions. Zygomycosis should be considered in immunosuppressed patients who develop sinusitis while receiving VRC prophylaxis, especially those with diabetes and malnutrition. [ABSTRACT FROM AUTHOR]