COVID-19-associated mucormycosis: a systematic review and meta-analysis of 958 cases.

BACKGROUND

Mucormycosis, a rare fungal infection, has shown an increase in the number of reported cases during the COVID-19 pandemic.

OBJECTIVES

To provide a comprehensive insight into the characteristics of COVID-19-associated mucormycosis, through a systematic review and meta-analysis.

METHODS OF DATA SYNTHESIS

Demographic information and clinical features were documented for each patient. Logistic regression analysis was used to predict the risk of mortality.

DATA SOURCES

PubMed, Scopus, Web of Science, Cochrane, CINAHL, Ovid MEDLINE, and FungiSCOPE.

STUDY ELIGIBILITY CRITERIA

Studies reporting individual-level information in patients with adult COVID-19-associated mucormycosis (CAM) between 1 January 2020 and 28 December 2022.

PARTICIPANTS

Adults who developed mucormycosis during or after COVID-19.

INTERVENTIONS

Patients with and without individual clinical variables were compared.

ASSESSMENT OF RISK OF BIAS

Quality assessment was performed based on the National Institutes of Health quality assessment tool for case series studies.

RESULTS

Nine hundred fifty-eight individual cases reported from 45 countries were eligible. 88.1% (844/958) were reported from low- or middle-income countries. Corticosteroid use for COVID-19 (78.5%, 619/789) and diabetes (77.9%, 738/948) were common. Diabetic ketoacidosis (p < 0.001), history of malignancy (p < 0.001), underlying pulmonary (p 0.017), or renal disease (p < 0.001), obesity (p < 0.001), hypertension (p 0.040), age (>65 years) (p 0.001), Aspergillus coinfection (p 0.037), and tocilizumab use during COVID-19 (p 0.018) increased the mortality. CAM occurred on an average of 22 days after COVID-19 and 8 days after hospitalization. Diagnosis of mucormycosis in patients with Aspergillus coinfection and pulmonary mucormycosis was made on average 15.4 days (range, 0-35 days) and 14.0 days (range, 0-53 days) after hospitalization, respectively. Cutaneous mucormycosis accounted for <1% of the cases. The overall mortality rate was 38.9% (303/780).

CONCLUSION

Mortality of CAM was high, and most reports were from low- or middle-income countries. We detected novel risk factors for CAM, such as older age, specific comorbidities, Aspergillus coinfection, and tocilizumab use, in addition to the previously identified factors.

Copyright © 2023 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.