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. 2022 Apr 21;9(7):ofac215.
doi: 10.1093/ofid/ofac215. eCollection 2022 Jul.

Clinical Characteristics, Health Care Utilization, and Outcomes Among Patients in a Pilot Surveillance System for Invasive Mold Disease-Georgia, United States, 2017-2019

Jeremy A W Gold  1 , Andrew Revis  2 , Stepy Thomas  2 , Lewis Perry  2 , Rebekah A Blakney  2 , Taylor Chambers  2 , Meghan L Bentz  1 , Elizabeth L Berkow  1 , Shawn R Lockhart  1 , Colleen Lysen  1 , Natalie S Nunnally  1 , Alexander Jordan  1 , Hilary C Kelly  1 , Alejandro J Montero  1 , Monica M Farley  2 , Nora T Oliver  2 , Stephanie M Pouch  3 , Andrew S Webster  2 , Brendan R Jackson  1 , Karlyn D Beer  1
Affiliations

Clinical Characteristics, Health Care Utilization, and Outcomes Among Patients in a Pilot Surveillance System for Invasive Mold Disease-Georgia, United States, 2017-2019

Jeremy A W Gold et al. Open Forum Infect Dis. .

Abstract

Background: Invasive mold diseases (IMDs) cause severe illness, but public health surveillance data are lacking. We describe data collected from a laboratory-based, pilot IMD surveillance system.

Methods: During 2017-2019, the Emerging Infections Program conducted active IMD surveillance at 3 Atlanta-area hospitals. We ascertained potential cases by reviewing histopathology, culture, and Aspergillus galactomannan results and classified patients as having an IMD case (based on European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group [MSG] criteria) or a non-MSG IMD case (based on the treating clinician's diagnosis and use of mold-active antifungal therapy). We described patient features and compared patients with MSG vs non-MSG IMD cases.

Results: Among 304 patients with potential IMD, 104 (34.2%) met an IMD case definition (41 MSG, 63 non-MSG). The most common IMD types were invasive aspergillosis (n = 66 [63.5%]), mucormycosis (n = 8 [7.7%]), and fusariosis (n = 4 [3.8%]); the most frequently affected body sites were pulmonary (n = 66 [63.5%]), otorhinolaryngologic (n = 17 [16.3%]), and cutaneous/deep tissue (n = 9 [8.7%]). Forty-five (43.3%) IMD patients received intensive care unit-level care, and 90-day all-cause mortality was 32.7%; these outcomes did not differ significantly between MSG and non-MSG IMD patients.

Conclusions: IMD patients had high mortality rates and a variety of clinical presentations. Comprehensive IMD surveillance is needed to assess emerging trends, and strict application of MSG criteria for surveillance might exclude over one-half of clinically significant IMD cases.

Keywords: antifungal drugs; invasive aspergillosis; invasive mold disease; mucormycosis; surveillance.

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Figures

Figure 1.
Figure 1.
Flow diagram depicting classification scheme for potential cases of invasive mold disease (IMD) in an active surveillance system. aPotential cases of IMD were classified using the 2020 European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (MSG) consensus definitions of invasive fungal diseases and based on clinician diagnosis and patient receipt of mold-active antifungal therapy (non-MSG IMD cases; https://academic.oup.com/cid/article/71/6/1367/5645434).
Figure 2.
Figure 2.
Flow diagram depicting case ascertainment and classification in an active surveillance system for invasive mold disease (IMD)—Georgia, 2017–2019. aA full list of specimen inclusion and exclusion criteria is available in the Supplementary Data. bPotential cases of IMD were classified using the 2020 European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (MSG) consensus definitions of invasive fungal diseases and based on clinician diagnosis and patient receipt of mold-active antifungal therapy (non-MSG IMD cases; https://academic.oup.com/cid/article/71/6/1367/5645434).
See this image and copyright information in PMC

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