title: A cluster of mucormycosis infections in hematology patients: challenges in investigation and control of invasive mold infections in high-risk patient populations.
abstract: Mucormycosis has been reported to be occurring more frequently in hematopoietic stem cell transplant (HSCT) recipients in recent years. We investigated a hospital cluster of mucormycosis cases among patients with hematologic disorders. Case-patients were identified through hospital microbiology and pathology database searches and compared to randomly selected controls matched on underlying disease and hospital discharge date using conditional logistic regression. Environmental assessments, including collection of samples for fungal cultures, were performed. Of 11 case-patients, 6 (55%) had acute myelogenous leukemia and 3 (27%) were allogeneic HSCT recipients. Five case-patients (45%) died. In univariate analysis, case-patients were more likely than controls to have refractory hematologic disease (odds ratio [OR], 13.75; 95% confidence interval [CI], 1.31-689); neutropenia >14 days (OR, 11.50; 95% CI, 1.27-558) or to have received voriconazole prophylaxis (OR, 11.26; 95% CI, 1.11-infinity). A point source was not identified. Factors such as underlying disease state and antifungal prophylaxis type may identify hematology patients at highest risk for mucormycosis. Our investigation highlighted critical knowledge gaps, including strain typing methods, the role of the hospital environment in mucormycosis outbreaks, and hospital environmental infection control measures most likely to reduce exposure of immunosuppressed persons to mucormycetes.
authors.affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA.
authors.forename: Eloisa
authors.initials: E
authors.lastname: Llata
authors.forename: David B
authors.initials: DB
authors.lastname: Blossom
authors.forename: H Jean
authors.initials: HJ
authors.lastname: Khoury
authors.forename: Carol Y
authors.initials: CY
authors.lastname: Rao
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Wannemuehler
authors.forename: Judith
authors.initials: J
authors.lastname: Noble-Wang
authors.forename: Amelia A
authors.initials: AA
authors.lastname: Langston
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Ribner
authors.forename: G Marshall
authors.initials: GM
authors.lastname: Lyon
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Arnold
authors.forename: Deonne R
authors.initials: DR
authors.lastname: Jackson
authors.forename: Mary E
authors.initials: ME
authors.lastname: Brandt
authors.forename: Tom M
authors.initials: TM
authors.lastname: Chiller
authors.forename: S Arunmozhi
authors.initials: SA
authors.lastname: Balajee
authors.forename: Arjun
authors.initials: A
authors.lastname: Srinivasan
authors.forename: Shelley S
authors.initials: SS
authors.lastname: Magill
mesh_terms: D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D004780:Environment, Controlled; D005260:Female; D005500:Follow-Up Studies; D006402:Hematologic Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000935:Antifungal Agents