Zygomycosis in a Tertiary-Care Cancer Center in the Era of Aspergillus-Active Antifungal Therapy: A Case-Control Observational Study of 27 Recent Cases

Background. Anecdotal evidence suggests a rise in zygomycosis in association with voriconazole (VRC) use in immunosuppressed patients. Methods. We performed prospective surveillance of patients with zygomycosis (group A; ) and comparednp 27 them with contemporaneous patients with invasive aspergillosis (group B; ) and with matched contempo-np 54 raneous high-risk patients without fungal infection (group C;). We also performed molecular typing and innp 54 vitro susceptibility testing of Zygomycetes isolates. Results. Nearly all patients with zygomycosis either had leukemia ( ) or were allogeneic bone marrownp 14 transplant recipients (). The Zygomycetes isolates (74 % of which were of the genus Rhizopus) had differentnp 13 molecular fingerprinting profiles, and all were VRC resistant. In multivariate analysis of groups A and C, VRC prophylaxis (odds ratio [OR], 10.37 [95 % confidence interval {CI}], 2.76–38.97];), diabetes (OR, 8.39Pp.001 [95 % CI, 2.04–34.35];), and malnutrition (OR, 3.70 [95 % CI, 1.03–13.27]; ) were found to bePp.003 Pp.045 independent risk factors for zygomycosis. Between patients with zygomycosis (after excluding 6 patients with mixed mold infections) and patients with aspergillosis, VRC prophylaxis (OR, 20.30 [95 % CI, 3.85–108.15];)Pp.0001 and sinusitis (OR, 76.72 [95 % CI, 6.48–908.15]; ) were the only factors that favored the diagnosis ofPp.001 zygomycosis