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Risk Factors of COVID-19 associated mucormycosis in Iranian patients: a multicenter study

2024; BioMed Central; Volume: 24; Issue: 1 Linguagem: Inglês

10.1186/s12879-024-09755-6

1471-2334

Bahram Eshraghi, Behzad Khademi, Majid Mirmohammadkhani, Gholamreza Khataminia, Hossein Ghahvehchian, Mohammad Yaser Kiarudi, Reza Nabie, Mohammad Mehdi Parandin, Paria Ghasemi Boroumand, Rasoul Mohammadi, Zahra Zia, Soroush Karamirad, Soheyla Jafarpour, Mostafa Fakoor, Mojtaba Varshochi, Kourosh Shahraki, Mohammad Reza Memarzadeh, Masoud Janipour, Atefe Mahdian Rad, Mohsen Bahmani Kashkouli, Farid Shekarchian, Vahideh Manouchehri, Abbas Khosravi, Mahdi Abounoori, Abazar Shahir, S. Mohammad Javad Sajjadi, Mohammad Etezad Razavi, Nastaran Hosseini, Fatemeh Ebrahimi, Pegah Noorshargh, Ali Forouhari, Mohsen Pourazizi,

Antifungal resistance and susceptibility

To evaluate the demographic, clinical, and prognostic characteristics of patients diagnosed with COVID-19-associated mucormycosis (CAM) in Iranian patients. This prospective observational study was conducted in 8 tertiary referral ophthalmology centers in different provinces of Iran during the fifth wave of the COVID-19 pandemic. All patients were subjected to complete history taking and comprehensive ophthalmological examination and underwent standard accepted treatment strategy based on the disease stage. Two hundred seventy-four CAM patients (most were males (150, 54.7%)) with a mean age of 56.8 ± 12.44 years were enrolled. Patients with a history of cigarette smoking (Adjusted Odds Ratio (AOR) = 4.36), Intensive Care Unit admission (ICU) (AOR = 16.26), higher stage of CAM (AOR = 2.72), and receiving endoscopic debridement and transcutaneous retrobulbar amphotericin B (AOR = 3.30) had higher odds of mortality. History of taking systemic corticosteroids during COVID-19 was significantly associated with reduced odds of mortality (AOR = 0.16). Generalized Estimating Equations analysis showed that the visual acuity of deceased patients (LogMAR: 3.71, 95% CI: 3.04–4.38) was worse than that of patients who were discharged from the hospital (LogMAR: 2.42, 95% CI: 2.16–2.68) (P < 0.001). This study highlights significant risk factors for mortality in patients with CAM, such as cigarette smoking, ICU admission, advanced CAM stages, receiving transcutaneous retrobulbar amphotericin B and worser visual acuity. Conversely, a history of systemic corticosteroid use during COVID-19 was linked to reduced mortality. These findings underscore the critical need for early identification and targeted interventions for high-risk CAM patients to improve clinical outcomes.