Outbreaks of Fungal Infections in Hospitals: Epidemiology, Detection, and Management

Abstract

Nosocomial clusters of fungal infections, whilst uncommon, cannot be predicted and are associated with significant morbidity and mortality. Here, we review reports of nosocomial outbreaks of invasive fungal disease to glean insight into their epidemiology, risks for infection, methods employed in outbreak detection including genomic testing to confirm the outbreak, and approaches to clinical and infection control management. Both yeasts and filamentous fungi cause outbreaks, with each having general and specific risks. The early detection and confirmation of the outbreak are essential for diagnosis, treatment of affected patients, and termination of the outbreak. Environmental sampling, including the air in mould outbreaks, for the pathogen may be indicated. The genetic analysis of epidemiologically linked isolates is strongly recommended through a sufficiently discriminatory approach such as whole genome sequencing or a method that is acceptably discriminatory for that pathogen. An analysis of both linked isolates and epidemiologically unrelated strains is required to enable genetic similarity comparisons. The management of the outbreak encompasses input from a multi-disciplinary team with epidemiological investigation and infection control measures, including screening for additional cases, patient cohorting, and strict hygiene and cleaning procedures. Automated methods for fungal infection surveillance would greatly aid earlier outbreak detection and should be a focus of research.

Invasive Fungal Infections in Children with Acute Leukemia: Epidemiology, Risk Factors, and Outcome

“…Based on current recommendations [ 17 ], this high rate of mold IFI in patients in the HR-IFI-AL group, along with high mortality in those who developed mold IFI, justifies anti-mold prophylaxis usage in such patients. Since almost all mold IFI in our center occurred during 2018/2019, when there was construction in the department, with virtually no instances in the study years before and after, a prophylactic approach is warranted during periods of construction in proximity to departments hospitalizing patients at risk [ 25 ]. In contrast, the rate of proven/probable mold IFI in patients in the non-HR-IFI-AL group was 1/41 (2.4%).…”

Molecular Diagnostics for Invasive Fungal Diseases: Current and Future Approaches

“…NGS also has important roles in epidemiological contexts including studies of fungal evolution, the mycobiome and host genomic susceptibility to IFDs, all of which are beyond the scope of this review. With respect to IFD outbreak investigations, we highlight some key developments, but also direct readers to recent comprehensive reviews [158,159].…”

“…The clinical utility of NGS within fungal outbreak situations is well established and comprehensively reviewed by Douglas et al [158]. Its application in the case clusters of yeasts, Pneumocystis, mould and endemic mycoses have met with varying degrees of success, depending on the pathogen.…”

“…Likewise, bioinformatic analyses are often laborious and require significant experience. For instance, further experience is required for cluster definitions by SNP distance; while this is well defined for yeast outbreaks, delineating mould outbreaks is more difficult [158]. Finally, limiting factors associated computing power, storage space, expertise and cost are especially applicable for medical mycology applications [194].…”