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Pediatr Infect Dis J. 2014 May;33(5):472-6. doi: 10.1097/INF.0000000000000261.

Mucormycosis outbreak associated with hospital linens.

Author information

1
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.

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.

PMID:
24667485
DOI:
10.1097/INF.0000000000000261
[Indexed for MEDLINE]

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