PURPOSE To report the incidence, cumulative mortality, and factors influencing the outcomes from a large series of COVID-19-associated mucormycosis (CAM) from western India. METHODS Consecutive patients with CAM between March 1 and May 10, 2021, with a minimum follow-up of 1 month were included. We recorded the presence of diabetes, use of steroids, and need for non-invasive ventilation (NIV) from the case files. The features of orbital involvement, treatment administered, and outcomes, i.e., death, orbital exenteration, or recovery were noted. Cumulative probability of adverse outcomes, defined as either death or exenteration, was reported using survival analysis. RESULTS We treated 67 cases of CAM and found an incidence of 13.6 cases per 1,000 patients post-moderate to severe COVID-19. Uncontrolled diabetes (90%) with ketoacidosis (40%) and prior systemic steroids (84%) were the strongest predispositions. The onset of CAM was 15.1 ± 9.5 days (range: 6-42 days) after recovery from COVID-19. The cumulative probability of an adverse outcome was 38% (95% confidence intervals [CI] = 23.7-56.9%) on day 20. The patients who required NIV during COVID-19 were at seven times higher risk of experiencing an adverse outcome (hazard ratios [HR] = 6.92, 95% CI = 2.9-16.2) while those who received amphotericin- -B had a 61% lower risk (HR = 0.39, 95% CI = 0.16-0.97). CONCLUSION The current outbreak of CAM was seen predominantly in uncontrolled diabetics, especially with ketoacidosis and steroid intake. The cumulative probability of death or orbital exenteration was 38% at day 20 of the infection and those who required NIV and did not receive amphotericin-B were at a high risk of these outcomes.

中文翻译：

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印度西部 COVID-19 相关毛霉菌病的发病率、累积死亡率和影响结果的因素。

目的 报告来自印度西部的大量 COVID-19 相关毛霉菌病 (CAM) 的发病率、累积死亡率和影响结果的因素。方法 纳入 2021 年 3 月 1 日至 5 月 10 日期间连续患有 CAM 的患者，至少随访 1 个月。我们从病例档案中记录了糖尿病的存在、类固醇的使用以及对无创通气 (NIV) 的需求。记录了眼眶受累、治疗和结局（即死亡、眼眶切除或恢复）的特征。使用生存分析报告了不良结果的累积概率，定义为死亡或清除。结果 我们治疗了 67 例 CAM，发现每 1,000 名中度至重度 COVID-19 患者的发病率为 13.6 例。未控制的糖尿病（90%）伴有酮症酸中毒（40%）和既往全身性类固醇（84%）是最强的易感性。从 COVID-19 康复后，CAM 的发作时间为 15.1 ± 9.5 天（范围：6-42 天）。在第 20 天，不良结果的累积概率为 38%（95% 置信区间 [CI] = 23.7-56.9%）。在 COVID-19 期间需要 NIV 的患者发生不良结果的风险高出 7 倍（危险比率 [HR] = 6.92, 95% CI = 2.9-16.2)，而接受两性霉素--B 治疗的患者风险降低 61% (HR = 0.39, 95% CI = 0.16-0.97)。结论 目前 CAM 的爆发主要见于未控制的糖尿病患者，尤其是酮症酸中毒和类固醇摄入。