Surveillance for Healthcare-Associated Mould Infections -- Case Series and Guideline Proposal

PRITI PATWARI, JAMES CUTRELL, ARCHANA BHASKARAN, SYLVIA TREVINO and PRANAVI SREERAMOJU

Author address: 

University of Texas-Southwestern, Dallas, TX

Abstract: 

Background: Opportunistic fungal infections are a threat to immunocompromised patients. Despite a lack of guidelines for mould surveillance, recent hospital construction highlighted the need for appropriate monitoring to detect potential nosocomial transmission at our institution. Methods: The setting is a 672-bed public academic hospital in Dallas, TX. We obtained a line list of positive fungal cultures from the microbiology lab, from 10/1/10 to 3/15/12, excluding yeasts, dermatophytes and endemic dimorphic fungi. Cases with diagnosis of mould infection upon histopathology were not included. We established case definitions for proven, probable, and possible invasive fungal infection (IFI) based on published literature. Hospital-onset (HO) was defined as onset of clinical symptoms/signs or isolation of mould at least seven days after hospital admission. Healthcare-associated community-onset (HACO) was defined as onset within seven days, but having contact with health system facilities within one month prior. We performed a focused medical record review to identify demographic and clinical data. Results: Sixty-nine cases were reviewed: 6 had previous infection, 14 were hospital-onset, 28 were HACO, and the remaining 21 had no prior contact with our facility. Of the 14 HO cases, 4 were proven IFI, 1 was probable IFI, and 9 were colonized. The proven IFI cases were: two patients with hematologic malignancy had sinusitis, 1 each with Aspergillus and Scopulariopsis ; one burn patient with disseminated Aspergillosis; and one immunocompetent patient with chronic Fusarium foot osteomyelitis. The probable HO IFI was Aspergillus skin graft infection in a burn victim. No patient met criteria for possible IFI. Of the 28 HACO cases, 1 was probable IFI with pulmonary Aspergillosis in a patient with renal transplant, 13 had chronic symptoms due to mould, and the remaining 14 represented colonization. The 21 cases without healthcare contact were: colonization 13, probable IFI 2 (1-Aspergillus , 1-Mucor ); the remaining 6 had insufficient clinical data. Conclusion: Absence of consensus in the literature for defining IFI in the healthcare setting limits surveillance efforts. We adapted existing criteria to include our burn population. Monitoring for mould infections may be of value, particularly during periods of construction.
2012

abstract No: 

1156

Full conference title: 

ID Week 2012
    • IDWeek 2012