Weekly Screening of Circulating Mucorales DNA and Early Treatment in Severely Burned Patients Improves Survival: Real-Life Bi-center Experience in France.

BACKGOUND: Invasive fungal diseases, among which includes invasive wound mucormycosis (IWM), are associated with poor outcomes in severely burned patients (SBPs). In recent years, quantitative real-time polymerase chain reaction (PCR) in serum to detect circulating Mucorales DNA (cmDNA) has shown promise for early diagnosis, reducing treatment duration and improving survival. Similarly, recent studies suggest that cmDNA detection enabled earlier diagnosis of IWM in SBPs. This retrospective study aimed to assess the impact of cmDNA-based diagnosis compared to conventional fungal culture on all-cause mortality at 30 and 100 days in SBPs.

METHODS

We retrospectively analyzed medical records of SBPs with proven or probable IWM over 2 periods, before and after the systematic implementation of cmDNA detection across 2 centers.

RESULTS

A total of 37 IWM patients were included. No significant differences were observed in clinical characteristics, treatment regimens, or disease severity between both groups. Our findings indicate that systematic cmDNA detection allowed earlier diagnosis of IWM with a median of -8 days [-16; -4] than mycological culture. The 100-day mortality was reduced from 63.6% to 30.8% (P = .071), and significantly reduced when considering only patients with total body surface area (TBSA) ≥ 30% (P = .047), in the cmDNA group. This earlier detection was associated with early initiation of liposomal amphotericin B-based therapy combined with surgery and may have contributed to the improved outcome.

CONCLUSIONS

cmDNA screening in targeted high-risk SBPs allows for earlier initiation of specific treatment and appears to improve the prognosis of IWM.