Different case definitions for invasive mold infections could lead to overlooked cases

August 02, 2021

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Although most facilities perform invasive mold infection surveillance in the context of health care, case definitions and approaches to environmental sampling vary significantly and could lead to missed cases, the researchers said.

“Invasive mold infections cause about 16,000 hospitalizations in the United States each year. More than half of the patients with these infections can die depending on the patient’s characteristics and the type of mold. ” Jeremy AW Gold, MD, MS, an Epidemic Intelligence Service official for the CDC’s Mycotic Diseases Division, Healio said.

Jeremy AW Gold

“When exposed to mold spores in healthcare patients, they can develop lung infections or infections in other parts of the body, including infections of the skin and the surgical site,” Gold said. “Because our team has studied many healthcare mold infections, we have seen firsthand that these infections are devastating to patients and causing financial and reputational damage to hospitals.”

While not all mold infections are preventable, Gold says healthcare facilities are taking special precautions to prevent patients from getting sick from indoor mold. Some facilities even use environmental air sampling techniques as part of their mold infection prevention efforts, but analyzing and interpreting air sampling can be challenging.

“We did this study because we wanted to understand how hospitals track mold infections in the healthcare context and how they use air sampling techniques for mold,” said Gold. “Systematically monitoring mold infections in hospital healthcare settings is key to detecting outbreaks, identifying hospital conditions that are putting patients at risk, and saving lives from these horrific infections.”

Gold and colleagues surveyed members of the Society for Healthcare Epidemiology of America Research Network (SRN) between June 29 and September 3, 2020 about invasive mold infection surveillance practices (HA-IMI), air sampling approaches, and existing collaborations between HA-IMI prevention actors and compared the responses between academic and non-academic hospitals.

Out of 71 eligible institutions, 37 (52.1%) completed the survey. Most of the respondents came from academic medical centers (n = 25; 67.6%) and stated that an intensive care unit (n = 35; 94.6%), a hematology-oncology unit (n = 30; 81.1 %) and a stem cell transplant are available (n = 24; 64.9%).

Overall, the survey showed that 35 (94.6%) of 37 hospitals monitored for HA-IMIs either prospectively (n = 24; 68.6%) or retrospectively (n = 11; 31st) during a suspected HA-IMI cluster , 4%). In addition, academic hospitals (n = 20, 83.3%) more frequently than non-academic hospitals (n = 4; 36.4%) carried out prospective monitoring for HA-IMIs (P = .02) and examined an HA-IMI- Clusters between 2018 and 2019 (n = 12 or 50% vs. 1 or 9.1%).

However, according to Gold, the most striking finding was that institutions differed greatly in terms of the case definitions used to define HA-IMIs and air sampling strategies used in the prevention of mold infections.

The survey found that the most widely 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 their own, self-developed case definition and eight hospitals (22.9%) did not provide an HA-IMI definition. Among the institutions using a custom case definition, notable responses include a case-by-case approach based on clinical characteristics (n = 7) and a definition based on test results. B. culture or histopathology (n = 2), regardless of the clinical correlation.

Because of this, Gold said the results suggest that mold infection outbreaks may be overlooked in some facilities and that approaches to air sampling are “all over the map”. He said clear and consistent guidance is needed to assist institutions with mold infection monitoring, health-related and air sampling for mold.

“Systematically monitoring hospital mold infections in hospitals is key to detecting outbreaks, finding hospital conditions that put patients at risk, and saving lives from these horrific infections,” said Gold. “Our results underscore the need for actionable guidelines to better protect vulnerable patients from healthcare-related mold infections.”

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