Disclosures: The authors report no relevant financial disclosures.
August 02, 2021
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Varied case definitions for invasive mold infections could lead to missed cases

Disclosures: The authors report no relevant financial disclosures.
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Despite most facilities performing surveillance for health care-associated invasive mold infections, case definitions and environmental sampling approaches vary substantially and could lead to missed cases, researchers said.

“Every year, invasive mold infections cause around 16,000 hospitalizations in the United States. More than half of patients with these infections may die, depending on patient characteristics and the type of mold involved,” Jeremy A.W. Gold, MD, MS, an Epidemic Intelligence Service officer for the CDC’s Mycotic Diseases Branch, told Healio.

Jeremy A.W. Gold

“When patients are exposed to mold spores in health care settings, they can develop pulmonary infections or infections in other body sites, including skin and surgical site infections,” Gold said. “Because our team has investigated many health care-associated mold infections, we’ve seen firsthand that these infections cause devastating effects on patients, as well as financial and reputational damage to hospitals.”

According to Gold, although not all mold infections are preventable, health care facilities take special precautions to keep patients from getting sick from indoor mold. Some facilities even use environmental air sampling techniques as part of their efforts to prevent mold infections, but the analysis and interpretation of air sampling can be challenging.

“We performed this study because we wanted to understand how hospitals track health care-associated mold infections and how they use air sampling techniques for mold,” Gold said. “Systematic surveillance for health care-associated mold infections in hospitals is key to detecting outbreaks, identifying hospital conditions that put patients at risk, and saving lives from these terrible infections.”

Gold and colleagues surveyed members of the Society for Healthcare Epidemiology of America Research Network (SRN) between June 29 and Sept. 3, 2020, on surveillance practices for health care-associated invasive mold infection (HA-IMI), air sampling approaches and existing collaborations among HA-IMI prevention stakeholders, and compared responses between academic and nonacademic hospitals.

Among 71 eligible facilities, 37 (52.1%) completed the survey. Most survey respondents were from academic medical centers (n = 25; 67.6%) and reported the presence of an ICU (n = 35; 94.6%), a hematology-oncology unit (n = 30; 81.1%) and a stem cell transplant program (n = 24; 64.9%).

Overall, the survey showed that 35 (94.6%) of 37 hospitals performed any surveillance for HA-IMIs, either prospectively (n = 24; 68.6%) or retrospectively (n = 11; 31.4%) during a suspected HA-IMI cluster. Additionally, academic hospitals (n = 20, 83.3%) were more likely than were nonacademic hospitals (n = 4; 36.4%) to perform prospective monitoring for HA-IMIs (P = .02) and to have investigated an HA-IMI cluster between 2018 and 2019 (n = 12 or 50% vs. 1 or 9.1%).

According to Gold, the most striking finding, however, was that facilities varied widely in terms of case definitions used to define HA-IMIs and air sampling strategies used in mold infection prevention efforts.

The survey showed that the most used HA-IMI case definition was developed by the European Organization for Research and Treatment of Cancer and the Mycoses Study Group (n = 15, 42.9%). Twelve hospitals (34.3%) reported using a custom case definition developed in-house and eight hospitals (22.9%) did not specify an HA-IMI definition. Among facilities using a custom case definition, notable responses included a case-by-case approach based on clinical features (n = 7) and a definition based on test results. such as culture or histopathology (n = 2), regardless of clinical correlation.

Because of this, Gold said the findings suggest that mold infection outbreaks may be missed in some facilities and that approaches to air sampling are “all over the map.” He said clear and consistent guidance is needed to help facilities with health care-associated mold infection surveillance and air sampling for mold.

“Systematic surveillance for health care-associated mold infections in hospitals is key to identifying outbreaks, finding hospital conditions that put patients at risk and saving lives from these terrible infections,” Gold said. “Our findings highlight the need for actionable guidance to better protect vulnerable patients from health care-associated mold infections.”