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Mucormycosis outbreak associated with hospital linens.
Pediatr Infect Dis J. 2014 May; 33(5):472-6.PI

Abstract

BACKGROUND

Mucormycosis is an invasive fungal infection with a high fatality rate. We investigated an outbreak of mucormycosis in a pediatric hospital to determine routes of pathogen transmission from the environment and prevent additional infections.

METHODS

A case was defined as a hospital-onset illness consistent with mucormycosis, confirmed by culture or histopathology. Case-patient medical records were reviewed for clinical course and exposure to items and locations within the hospital. Environmental samples were collected from air and surfaces. Fungal isolates collected from case-patients and the environmental samples were identified using DNA sequencing.

RESULTS

Five case-patients had hospital-associated cutaneous mucormycosis over an 11-month period; all subsequently died. Three case-patients had conditions known to be associated with susceptibility to mucormycosis, while 2 had cardiac conditions with persistent acidosis. The cases occurred on several different wards throughout the hospital, and hospital linens were the only exposure identified as common to the case-patients. Rhizopus species were recovered from 26 (42%) of 62 environmental samples from clean linens and associated areas and from 1 (4%) of 25 samples from nonlinen-related items. Case-patients were infected with Rhizopus delemar, which was also isolated from cultures of clean linens and clean linen delivery bins from the off-site laundry facility.

CONCLUSIONS

Hospital linens were identified as a vehicle that carried R. delemar into contact with susceptible patients. Fungal species identification using DNA-based methods is useful for corroborating epidemiologic links in hospital outbreak investigations. Hospital linens should be laundered, packaged, shipped and stored in a manner that minimizes exposure to environmental contaminants.

Authors+Show Affiliations

From the *Epidemic Intelligence Service; †Division of Healthcare Quality Promotion; ‡Mycotic Diseases Branch; and §Epidemiology Elective Program, Centers for Disease Control and Prevention, Atlanta, GA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24667485

Citation

Duffy, Jonathan, et al. "Mucormycosis Outbreak Associated With Hospital Linens." The Pediatric Infectious Disease Journal, vol. 33, no. 5, 2014, pp. 472-6.
Duffy J, Harris J, Gade L, et al. Mucormycosis outbreak associated with hospital linens. Pediatr Infect Dis J. 2014;33(5):472-6.
Duffy, J., Harris, J., Gade, L., Sehulster, L., Newhouse, E., O'Connell, H., Noble-Wang, J., Rao, C., Balajee, S. A., & Chiller, T. (2014). Mucormycosis outbreak associated with hospital linens. The Pediatric Infectious Disease Journal, 33(5), 472-6. https://doi.org/10.1097/INF.0000000000000261
Duffy J, et al. Mucormycosis Outbreak Associated With Hospital Linens. Pediatr Infect Dis J. 2014;33(5):472-6. PubMed PMID: 24667485.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mucormycosis outbreak associated with hospital linens. AU - Duffy,Jonathan, AU - Harris,Julie, AU - Gade,Lalitha, AU - Sehulster,Lynne, AU - Newhouse,Emily, AU - O'Connell,Heather, AU - Noble-Wang,Judith, AU - Rao,Carol, AU - Balajee,S Arunmozhi, AU - Chiller,Tom, PY - 2014/3/27/entrez PY - 2014/3/29/pubmed PY - 2014/12/17/medline SP - 472 EP - 6 JF - The Pediatric infectious disease journal JO - Pediatr Infect Dis J VL - 33 IS - 5 N2 - BACKGROUND: Mucormycosis is an invasive fungal infection with a high fatality rate. We investigated an outbreak of mucormycosis in a pediatric hospital to determine routes of pathogen transmission from the environment and prevent additional infections. METHODS: A case was defined as a hospital-onset illness consistent with mucormycosis, confirmed by culture or histopathology. Case-patient medical records were reviewed for clinical course and exposure to items and locations within the hospital. Environmental samples were collected from air and surfaces. Fungal isolates collected from case-patients and the environmental samples were identified using DNA sequencing. RESULTS: Five case-patients had hospital-associated cutaneous mucormycosis over an 11-month period; all subsequently died. Three case-patients had conditions known to be associated with susceptibility to mucormycosis, while 2 had cardiac conditions with persistent acidosis. The cases occurred on several different wards throughout the hospital, and hospital linens were the only exposure identified as common to the case-patients. Rhizopus species were recovered from 26 (42%) of 62 environmental samples from clean linens and associated areas and from 1 (4%) of 25 samples from nonlinen-related items. Case-patients were infected with Rhizopus delemar, which was also isolated from cultures of clean linens and clean linen delivery bins from the off-site laundry facility. CONCLUSIONS: Hospital linens were identified as a vehicle that carried R. delemar into contact with susceptible patients. Fungal species identification using DNA-based methods is useful for corroborating epidemiologic links in hospital outbreak investigations. Hospital linens should be laundered, packaged, shipped and stored in a manner that minimizes exposure to environmental contaminants. SN - 1532-0987 UR - https://www.unboundmedicine.com/medline/citation/24667485/Mucormycosis_outbreak_associated_with_hospital_linens_ L2 - https://doi.org/10.1097/INF.0000000000000261 DB - PRIME DP - Unbound Medicine ER -