Culture-Documented Invasive Mold Infections at MD Anderson Cancer Center in Houston, Texas, Pre– and Post–Hurricane Harvey

Author: 

Dimitrios P Kontoyiannis, Emily C Shah, Sebastian Wurster, Samuel L Aitken, Linda Graviss, Issam I Raad, Roy F Chemaly
Open Forum Infectious Diseases, Volume 6, Issue 4, April 2019, ofz138

Abstract: 

Background

Extensive floodwater damage following hurricane Harvey raised concerns of excess mold infections in immunocompromised patients. This study sought to evaluate the impact of hurricane Harvey on the incidence of culture-positive invasive mold infections (cIMIs) in patients treated at MD Anderson Cancer Center (MDACC; Houston, TX).

Methods

All mold-positive culture results in the Microbiology Laboratory at MDACC in a 12-month period before and after hurricane Harvey were reviewed. cIMI cases were defined according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria. Rates and causative agents of cIMIs pre- and post-Harvey were compared. In addition, we evaluated institution-wide trends in the use of systemically administered mold-active antifungal agents by segmented regression analysis.

Results

Inpatient cIMI rates per 1000 patient-days were comparable in the pre- and post-Harvey observation period (0.17 vs 0.21, P = .36). During both surveillance periods, the vast majority of cIMI cases were due to Aspergillus spp., Fusarium spp., or Mucorales. No emergence of unusual mold infections was seen, and the relative frequencies of mold genera recovered from cultures at the MDACC Microbiology Laboratory remained largely unaltered. The overall use of posaconazole was significantly higher in the post-Harvey period and the use of both voriconazole and liposomal amphotericin B began to increase significantly immediately after Harvey.

Conclusions

Our monocentric study employing stringent culture-based definitions of mold infections found no excess cases of IMIs in MDACC’s immunosuppressed patient population in the aftermath of a major flooding event. Increased use of some mold-active antifungals in the aftermath of hurricane Harvey was observed institutionally.