Illustrating the clinical landscape of Mucorales infection: a comprehensive examination of demographic characteristics, regional variation, length of stay, and readmission rates of cases in the United States
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Abstract
Mucormycosis is a rare but devastating fungal infection that primarily afflicts immunocompromised patients including those with hematological malignancy, solid organ and bone marrow transplants, and diabetes mellitus. The objective of this study was to assess the prevalence and clinical burden of mucormycosis among hospitalized patients in the United States. The three studies conducted analyzed the Oracle Health Facts® database, a deidentified electronic health record resource, which includes more than 750 participating healthcare facilities, 500 million unique patient encounters, 69 million patients, and 4.7 billion laboratory results between 2000 and 2018. All inpatient hospitalizations were examined for documentation of mucormycosis using an ICD-9-CM code of 117.7 or ICD-10-CM codes of B46.0-B46.9. In study 1, we estimated the prevalence of mucormycosis-related hospitalizations nationally, by census region and demographic characteristics, and described temporal trends. In study 2, we conducted a matched case-control study design to estimate the association of mucormycosis on length of hospital stay. Controls were matched by facility, year of case, sex and age. Finally, in study 3, we conducted a matched case-control study to estimate readmission rates at 30- and 90-days for mucormycosis patients compared to control patients.
Results: The prevalence of mucormycosis-related hospitalizations was estimated as 0.12 per 100,000 discharges during January 2000 to June 2018. The highest prevalence and number of cases occurred in western states (i.e. Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming). We also found a higher prevalence of mucormycosis among patients with coagulopathy, chronic heart failure, weight loss and cardiac arrythmias. This analysis confirmed prior findings that mucormycosis was more common among patients with diabetes mellitus, hematological malignancies, and fluid and electrolyte disorders.
Mucormycosis was associated with longer inpatient stays; the average length of stay for mucormycosis patients was 23 days compared to 6 days for controls matched by facility, year, sex and age. Regression analyses found that mucormycosis was a significant predictor of increased length of hospital stay, adding almost two days on average compared to matched controls.
Mucormycosis patients also had a higher rate of readmission than control patients; they had 30-day readmission rates 35 times higher and 90-day readmission rates more than four times that of controls.
Conclusions: While mucormycosis is not a common infection documented in US patients, it has a significant impact of patient length of stay and hospital readmission rates. The study provides an estimate of the prevalence and burden of mucormycosis among US hospital patients. The significant clinical and patient burden associated with mucormycosis showcases the importance of surveillance and understanding required to further optimize treatment protocols and protect susceptible US patients.
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Introduction -- Review of literature -- Data description -- Pathogenesis of Mucorales -- Prevalence and epidemiology of mucormycosis -- Length of stay -- Readmission rates -- Overview
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Ph.D. (Doctor of Philosophy)