Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium

Mould Infections of Traumatic Wounds: A Brief Narrative Review

“…The reported incidence of post-traumatic mould infections among the general population is frequently unseparated from that of other types of mould infections, e.g., approximately 0.43-1.7 cases per million persons have been reported for mucormycosis [4,[15][16][17]. Nonetheless, two important factors should be necessarily considered when interpreting these epidemiological data: (1) owing to the difficulties of diagnosing mould infections outside specific contexts, there could be an underestimation of incidence in the general population [18]; (2) incidence and prevalence of post-traumatic mould infections are undoubtedly higher in specific populations at risk (e.g., soldiers) [4,10]. It is also worth mentioning that an important factor hampering the comparison of incidence and/or prevalence data across different studies, even when conducted in similar populations, is the frequent use of different denominators (e.g., person-time, number of patients, number of patient at risk, number of patients with wound infection) [18].…”

“…Nonetheless, two important factors should be necessarily considered when interpreting these epidemiological data: (1) owing to the difficulties of diagnosing mould infections outside specific contexts, there could be an underestimation of incidence in the general population [18]; (2) incidence and prevalence of post-traumatic mould infections are undoubtedly higher in specific populations at risk (e.g., soldiers) [4,10]. It is also worth mentioning that an important factor hampering the comparison of incidence and/or prevalence data across different studies, even when conducted in similar populations, is the frequent use of different denominators (e.g., person-time, number of patients, number of patient at risk, number of patients with wound infection) [18]. Nonetheless, while keeping in mind these important limitations, two general features of the epidemiology of post-traumatic mould infections can be extrapolated from the available data.…”

“…The classical laboratory diagnostic approach to post-traumatic mould infections consists of microscopy, culture, and histopathology of infected tissues. Presumptive identification and differentiation of Mucorales from other moulds can be obtained through microscopy of wound specimens with fluorescent brighteners, although with possible suboptimal sensitivity (for both identification and differentiation) and with no identification at the genus and species level, which is achievable with culture [18,52,53]. Nonetheless, also cultures may be hampered by suboptimal/variable sensitivity [4,53].…”

Quantifying guideline adherence in mucormycosis management using the EQUAL score

“…Definitive proof involves tis- Guidelines lead through the complex management pathways and support clinical decisions. 7,8 However, mucormycosis guideline adherence is rarely reported. The difficulty quantifying adherence may be one reason.…”

“…In 2018, the European QUALity (EQUAL) Score was derived from current guidelines and converts guideline recommendations into score points. 8,9 By applying the EQUAL Score, our study evaluates the management of mucormycosis at the University Hospital of Cologne, Germany. The study is part of a teaching project at our university, as previously described.…”