Öz
Giriş: Hindistan’da kontrolsüz diyabetli hastalar arasında yüksek oranda mukormikoz görülmektedir. Mukormikozun tahmini prevalansının 100.000 kişi başına 0,02 ila 9,5 olgu olduğu tahmin edilmektedir. İkinci dalga sırasında, steroidlerin gelişigüzel kullanılmasından ve hem hastanede hem de evde enfeksiyon kontrol uygulamalarındaki aksaklıklardan kaynaklanabilecek lokalize bir mukormikoz salgını vardı. Bu enfeksiyonun tedavisi, oldukça invazif olması ve bazı antifungal ajanlara karşı doğası gereği dirençli olması nedeniyle zordur. Bu çalışma, Koronavirüs hastalığı-2019 (COVID-19) öncesi ve COVID-19 döneminde mukormikoz prevalansını ve klinik görünümünü karşılaştırmak ve ayrıca her iki dönemde de mukormikozun antifungal duyarlılık testi (AFST) paternini karşılaştırmak için yapıldı.
Gereç ve Yöntem: Bu, Chennai’deki üçüncü basamak bir sağlık merkezine COVID-19 öncesi ve COVID-19 döneminde kabul edilen hastaları içeren tek merkezli, retrospektif bir çalışmadır. Örneklerin kültürü yapıldı ve kültür pozitif izolatlar için CLSI M38-A2’ye göre mikro sıvı besiyeri seyreltme yöntemiyle amfoterisin B, itrakonazol, posakonazol, vorikonazol ve izavukonazol ile AFST yapıldı.
Bulgular: COVID-19 öncesi dönemde laboratuvara alınan 365 numunenin 52’si kanıtlanmış mukormikoz olgularına ait idi. COVID-19 döneminde alınan toplam 886 numuneden 174’ü kanıtlanmış mukormikoz olgularına ait idi. Mukormikozis insidansı COVID-19 döneminde yüksekti. Risk faktörlerinin ve klinik tabloların çoğu, COVID-19 öncesi dönemde ve COVID-19 döneminde benzerdi. Yine de, ikinci dönemde klinik komplikasyonlar daha yaygındı. Amfoterisin B’nin ortalama MİK değerlerinin COVID-19 öncesi dönemde COVID-19 dönemine göre yüksek olması ve posakonazolün COVID-19 döneminde COVID-19 öncesine göre ortalama MİK değerinin daha yüksek olması bu mantar önleyici ilaçların kullanımının artmasına bağlı olabilir. İzavukonazol gibi daha yeni bir azol, MİK değerlerinin düşük bulunması nedeniyle dirençli enfeksiyonların gelecekteki tedavisi için iyi bir tedavi seçeneği olarak düşünülebilir.
Sonuç: Mukormikoz tanısı alan hastaların zamanında yönetimi ve AFST yapılarak doğru antifungal ajan seçimi, sonuçların iyileşmesine ve direnç gelişimiyle mücadeleye yardımcı olacaktır.
Anahtar Kelimeler: Mukormikoz, COVID-19 öncesi dönem, COVID-19 dönemi, antifungal duyarlılık testi
Kaynakça
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