covid-19 associated mucormycosis and risk factors: a case-control study from turkey

Background: mucormycosis, a fatal fungal infection, has increased during the covid-19 pandemic and posed significant challenges for clinicians. objectives: our research focused on identifying the clinical traits of patients with covid-19-associated mucormycosis (cam), comparing them with a control group, and identifying risk factors for the development of cam. methods: our study was conducted on 39 cam patients and 78 control patients from september 2020 to october 2022 at a tertiary education center and regional hospital. the control group was selected blindly in a 1:2 ratio among patients who did not develop mucormycosis, were hospitalized due to covid-19, and were either discharged or deceased. the control group was matched to the case group regarding age and hospitalization date. to test potential risk factors for cam, we performed a binary logistic regression analysis. the variables included in the multivariate binary logistic regression model were gender, diabetes, cumulative steroid dose (dexamethasone equivalent), duration of steroid treatment, and tocilizumab/anakinra treatment. results: in our study, 39 patients were diagnosed with cam. the average age of the patients was 66 ± 11.5 years. of the patients, 54.7% (n = 64) were male, with a statistically significantly higher proportion of men in the cam group (74.4% vs. 44.9%, p = 0.003). the diabetes rate was 51.3% (n = 60) among all patients, and it was higher in the cam group (69.2% vs. 42.3%, p = 0.006). regarding in-hospital mortality, the rate was higher in the cam group (56.4% vs. 14.1%, p < 0.001). the median length of stay in the hospital was 37 days for the cam group and 10 days for the control group (p < 0.001). the cumulative steroid dose was elevated in the cam group compared to the control group (191 ± 61.4 mg vs. 117 ± 69.8 mg, p < 0.001). the duration of steroid treatment was 16.5 ± 6.2 days in the cam group, compared to 9.8 ± 4.7 days in the control group (p < 0.001). among cam cases, paranasal involvement was the most common (56.4%), followed by rhino-orbital involvement (33.3%).in binary logistic regression analysis, male gender (or, 3.9; 95% ci, 1.4 – 11.3), diabetes mellitus (or, 4.4; 95% ci, 1.5 – 12.4), more than ten days of steroid use (or, 5.5; 95% ci, 1.3 – 22.4), and tocilizumab/anakinra use (or, 0.23; 95% ci, 0.06 – 0.8) were identified as risk factors for the development of cam (p values 0.011, 0.005, 0.019, and 0.020, respectively). conclusions: male gender, diabetes mellitus, and steroid use for more than ten days were identified as positive risk factors, while tocilizumab/anakinra use was identified as a negative risk factor for the development of cam.