Pulmonary mucormycosis: outcomes by treatment modality and underlying comorbidity.

Abstract

Pulmonary mucormycosis is an uncommon highly morbid opportunistic fungal infection that most often affects immunocompromised patients with multiple comorbidities. We performed a single-center review of patients diagnosed with pulmonary mucormycosis from 2000-2021 to determine factors associated with selection for surgical intervention, hospital mortality, and overall survival. Factors associated with discharge status were analyzed with logistic regression. Overall survival was compared with log-rank tests. We identified 86 patients with pulmonary mucormycosis. The median age was 62 years (interquartile range, 51-67 years); 62 (72.1%) were male. Fifty-four patients (62.8%) had an underlying hematologic malignancy and 22 (25.6%) had a history of solid organ transplantation. Hospital mortality was 46.5%. Patients treated with a combination of surgical resection and antifungal therapy were more likely to discharge alive than those treated with antifungal therapy only (73.2% vs 35.6%, P < .001). Forty-one patients (47.7%) underwent surgical resection. The most common operations were lobectomy (19 patients, 46.3%) and wedge resection (15 patients, 36.6%). Four patients (9.8%) underwent pneumonectomy and 8 patients (19.5%) underwent extrapulmonary resection in addition to lung resection. Median overall survival in patients with hematologic malignancy was lower than those with a solid organ transplant in both the entire cohort (0.20 vs 5.33 years, P = .006) and the surgical cohort (0.57 vs 8.19 years, P = .056). Surgical resection is associated with increased survival to discharge in carefully selected patients with pulmonary mucormycosis, and should be considered in suitable operative candidates even with bilateral and extrapulmonary disease. Underlying hematologic malignancy is associated with poor long-term survival regardless of treatment modality.