344. Cluster of Mucormycosis Infections among Patients with Hematologic Malignancies Kansas, 2014
Session: Poster Abstract Session: HAI: Outbreaks
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • Final MUCOR POSTER.pdf (447.3 kB)
  • Background: Mucormycosis is a life-threatening fungal infection primarily affecting people who are immunocompromised or have diabetic ketoacidosis (DKA). Outbreaks are rare, but often associated with environmental exposures.  In December 2014, an increase in rhinocerebral mucormycosis (RCM) was identified among patients with hematologic malignancies on adjacent hospital wards, A and B. We aimed to identify the source and prevent further infections.

    Methods: A healthcare-associated case was defined as laboratory-confirmed RCM occurring during 2014 in a patient with a hematologic malignancy and admission to ward A or B for ≥5 days during the 30 days (probable case) or 45 days (suspect case) prior to initiating RCM treatment. Laboratory results, medical charts, and facility practices were reviewed.  Possible RCM risk factors were evaluated by an unmatched case-control study; controls were 18 randomly selected hematologic malignancy patients staying on ward A or B for ≥5 days from May–December 2014.

    Results: Five cases (4 probable; 1 suspect) were identified; all occurred July–November 2014. Patients had debridement (n=4) and enucleation (n=2); two died.  One patient had been prescribed posaconazole prophylaxis for >30 days prior to RCM diagnosis. No patients had DKA; diabetes (OR=20, 95% CI=1.6-248.0) and diabetes with hyperglycemia (blood glucose>300 mg/dL) ≤30 days before initiating RCM treatment (OR=12, 95% CI=1.2-121.6) were associated with being a case. Residing on ward B (3 patients) versus ward A (1 patient) was not associated with being a case (P>0.99). Major construction occurred June–October 2014 on ward A. Ward A construction was completed prior to the investigation; review of facility practices indicated that ward A and B patients shared hallways with construction traffic.

    Conclusion: Among patients with hematologic malignancies, diabetes and hyperglycemia are risk factors for RCM, which can occur despite posaconazole prophylaxis. Ward A construction might have increased exposure to fungal spores via construction traffic in patient hallways. While further evaluation is needed to assess the infection risk of such practices, hospitals should be aware that construction and construction traffic can impact adjacent patient care areas.

    Meghan Lyman, MD1,2, Tiffany Walker, MD2,3, Lauren Leigh Smith, MD4, Robert Geist, MPH, CIC5, Sheri Tubach, MPH, MS6, Anne Straily, DVM, MPH6, Joseph Scaletta, MPH, BSN, RN, CIC5, Shawn Lockhart, PhD7, Rachel M. Smith, MD, MPH7,8 and Maroya Walters, PhD9, (1)National Center for Emerging and Zoonotic Infectious Diseases Division for Healthcare Quality Promotion, Center for Disease Control and Prevention, Atlanta, GA, (2)Epidemic Intelligence Service, Center for Disease Control and Prevention, Atlanta, GA, (3)Mycotic Diseases Branch, Center for Disease Control and Prevention, Atlanta, GA, (4)Center For Disease Control and Prevention, Atlanta, GA, (5)Healthcare-Associated Infections Program, Kansas Department of Health and Environment, Topeka, KS, (6)Bureau of Epidemiology and Public Health Informatics, Kansas Department of Health and Environment, Topeka, KS, (7)Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (8)Centers for Disease Control and Prevention, Atlanta, GA, (9)Division of Healthcare Quality Promotion, Center for Disease Control and Prevention, Atlanta, GA

    Disclosures:

    M. Lyman, None

    T. Walker, None

    L. L. Smith, None

    R. Geist, None

    S. Tubach, None

    A. Straily, None

    J. Scaletta, None

    S. Lockhart, None

    R. M. Smith, None

    M. Walters, None

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