title: Healthcare-associated mucormycosis.
abstract: Mucormycosis is a severe emerging invasive fungal infection that occurs as a consequence of environmental exposure. We exhaustively reviewed all the cases of mucormycosis (European Organisation for Research and Treatment of Cancer/Mycoses Study Group 2008 criteria) attributed to healthcare procedures that occurred between 1970 and 2008. A total of 169 cases were studied (29% children, 61% male). Major underlying diseases were solid organ transplantation (24%), diabetes mellitus (22%), and severe prematurity (21%). Skin was the most common localization (57%), followed by gastrointestinal tract (15%). Culture results were available in 75% (92% positive), and results of histological examination were positive in 95%. Rhizopus was the most frequent genus (43%). Infection portal of entry included surgery and presence of medical devices such as catheters or adhesive tape. Outbreaks and clusters were related to adhesive bandages (19 cases), wooden tongue depressors (n = 5), ostomy bags (n = 2), water circuitry damage (n = 2), and adjacent building construction (n = 5). Thorough investigations are mandatory to identify healthcare-associated mucormycosis, notably in neonatology, hematological, and transplantation units.
authors.affiliation: Sorbonne Paris Cité, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, APHP, Université Paris-Descartes, Centre d'Infectiologie Necker-Pasteur, 149 rue de Sèvres, Paris Cedex 15, France.
authors.forename: Blandine
authors.initials: B
authors.lastname: Rammaert
authors.forename: Fanny
authors.initials: F
authors.lastname: Lanternier
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.forename: Eric
authors.initials: E
authors.lastname: Dannaoui
authors.forename: Marie-Elisabeth
authors.initials: ME
authors.lastname: Bougnoux
authors.forename: Marc
authors.initials: M
authors.lastname: Lecuit
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001458:Bandages / Q000382:microbiology; D002648:Child; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology / Q000635:transmission*; D003881:Dermatomycoses / Q000382:microbiology / Q000473:pathology; D003920:Diabetes Mellitus / Q000382:microbiology / Q000473:pathology; D004196:Disease Outbreaks; D004866:Equipment Contamination; D005260:Female; D041981:Gastrointestinal Tract / Q000382:microbiology / Q000473:pathology; D006801:Humans; D008168:Lung / Q000382:microbiology / Q000473:pathology; D008297:Male; D009091:Mucormycosis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology / Q000635:transmission*; D016377:Organ Transplantation / Q000009:adverse effects; D012233:Rhizopus / Q000472:pathogenicity*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents