1410. Mucormycosis Among Solid Organ Transplant Recipients at an Acute Care Hospital — Pennsylvania, 2014-2015
Session: Poster Abstract Session: HAI: Outbreaks
Friday, October 28, 2016
Room: Poster Hall
Background: Mucormycosis is a rare, often fatal, infection caused by a group of angioinvasive molds and typically occurs among persons with marked immunosuppression. In September 2015, the Pennsylvania Department of Health reported a mucormycosis cluster among solid organ transplant recipients (SOTR) at an acute care hospital. Our objective was to identify possible sources and prevent additional infections.

Methods: Healthcare-associated cases were defined as mucormycosis among SOTR, diagnosed ≥14 days after admission during June 2014–September 2015. We reviewed microbiology and histopathology records, abstracted medical charts, interviewed staff, and performed an environmental assessment and cohort and nested case-control studies.

Results: Four cases (3 probable, 1 suspect) caused by three Mucorales species were identified. The 3 probable case-patients had undergone heart or lung transplantation and received care in the cardiothoracic intensive care unit (CTICU), which was closed for deconstruction prior to our investigation. While the probable case-patients had no documented indication for negative-pressure isolation, all 3 had prolonged stays in the CTICU’s only negative-pressure room. In a cohort of 124 heart or lung SOTR cared for throughout the hospital, 3 (43%) of 7 patients exposed to this negative pressure room developed mucormycosis, compared with none of those unexposed (P<.001). A nested case-control study of CTICU patients showed only exposure to the negative-pressure room to be associated with mucormycosis (odds ratio: 51.3; 95% confidence interval: 5.9–infinity).

Conclusion: Our investigation of mucormycosis infections identified negative-pressure isolation as a contributing factor. Negative-pressure isolation may increase the risk of mucormycosis in immunocompromised patients by concentrating dust and mold spores. Although not addressed in current guidelines, healthcare facilities should avoid housing immunosuppressed SOTR in negative-pressure rooms unless medically indicated.

Amber Vasquez, MD, MPH1, Shannon Novosad, MD, MPH2, Erick Christensen, MPH3, Heather Moulton-Meissner, PHD2, M. Shannon Keckler, PHD4, Matthew Arduino, MS, DrPH1, Carolyn Gould, MD, MSCR1, Tom Chiller, MD, MPH5, Joseph Perz, DrPH MA6, Atmaram Nambiar, MD, MPH7, J. Todd Weber, MD, FACP, FIDSA8, Mary Brandt, PhD1, Alison S. Laufer-Halpin, Ph.D.2 and Rajal K. Mody, MD, MPH5, (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (3)University of Utah School of Medicine, Salt Lake City, UT, (4)Centers for Disease Control and Prevention, atlanta, GA, (5)Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (6)Centers for Diseases Control and Prevention, Atlanta, GA, (7)Pennsylvania Department of Health, Harrisburg, PA, (8)Division of Healthcare Quality Promotion, Ncezid, Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

A. Vasquez, None

S. Novosad, None

E. Christensen, None

H. Moulton-Meissner, None

M. S. Keckler, None

M. Arduino, None

C. Gould, None

T. Chiller, None

J. Perz, None

A. Nambiar, None

J. T. Weber, None

M. Brandt, None

A. S. Laufer-Halpin, None

R. K. Mody, None

See more of: HAI: Outbreaks
See more of: Poster Abstract Session

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.