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Investigation of a Prolonged and Large Outbreak of Healthcare-Associated Mucormycosis Cases in an Acute Care Hospital-Arkansas, June 2019-May 2021.
Jordan, Alexander; James, Allison E; Gold, Jeremy A W; Wu, Karen; Glowicz, Janet; Wolfe, Frankie; Vyas, Keyur; Litvintseva, Anastasia; Gade, Lalitha; Liverett, Hazel; Alverson, Mary; Burgess, Mary; Wilson, Amy; Li, Ruoran; Benowitz, Isaac; Gulley, Trent; Patil, Naveen; Chakravorty, Rohan; Chu, Winston; Kothari, Atul; Jackson, Brendan R; Garner, Kelley; Toda, Mitsuru.
  • Jordan A; Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • James AE; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Gold JAW; Arkansas Department of Health, Little Rock, Arkansas, USA.
  • Wu K; Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Glowicz J; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Wolfe F; Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Vyas K; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Litvintseva A; Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Gade L; Medical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
  • Liverett H; Medical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
  • Alverson M; Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Burgess M; Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Wilson A; Medical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
  • Li R; Medical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
  • Benowitz I; Medical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
  • Gulley T; Medical Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
  • Patil N; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Chakravorty R; Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Chu W; Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Kothari A; Arkansas Department of Health, Little Rock, Arkansas, USA.
  • Jackson BR; Arkansas Department of Health, Little Rock, Arkansas, USA.
  • Garner K; Arkansas Department of Health, Little Rock, Arkansas, USA.
  • Toda M; Arkansas Department of Health, Little Rock, Arkansas, USA.
Open Forum Infect Dis ; 9(10): ofac510, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2212862
ABSTRACT

Background:

Outbreaks of healthcare-associated mucormycosis (HCM), a life-threatening fungal infection, have been attributed to multiple sources, including contaminated healthcare linens. In 2020, staff at Hospital A in Arkansas alerted public health officials of a potential HCM outbreak.

Methods:

We collected data on patients at Hospital A who had invasive mucormycosis during January 2017-June 2021 and calculated annual incidence of HCM (defined as mucormycosis diagnosed within ≥7 days after hospital admission). We performed targeted environmental assessments, including linen sampling at the hospital, to identify potential sources of infection.

Results:

During the outbreak period (June 2019-June 2021), 16 patients had HCM; clinical features were similar between HCM patients and non-HCM patients. Hospital-wide HCM incidence (per 100 000 patient-days) increased from 0 in 2018 to 3 in 2019 and 6 in 2020. For the 16 HCM patients, the most common underlying medical conditions were hematologic malignancy (56%) and recent traumatic injury (38%); 38% of HCM patients died in-hospital. Healthcare-associated mucormycosis cases were not epidemiologically linked by common procedures, products, units, or rooms. At Hospital A and its contracted offsite laundry provider, suboptimal handling of laundered linens and inadequate environmental controls to prevent mucormycete contamination were observed. We detected Rhizopus on 9 (9%) of 98 linens sampled at the hospital, including on linens that had just arrived from the laundry facility.

Conclusions:

We describe the largest, single-center, HCM outbreak reported to date. Our findings underscore the importance of hospital-based monitoring for HCM and increased attention to the safe handling of laundered linens.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study Language: English Journal: Open Forum Infect Dis Year: 2022 Document Type: Article Affiliation country: Ofid

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study Language: English Journal: Open Forum Infect Dis Year: 2022 Document Type: Article Affiliation country: Ofid