{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T16:34:41Z","timestamp":1789058081612,"version":"build-2803163510"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,10,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Outbreaks of healthcare-associated mucormycosis (HCM), a life-threatening fungal infection, have been attributed to multiple sources, including contaminated healthcare linens. In 2020, staff at Hospital A in Arkansas alerted public health officials of a potential HCM outbreak.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We collected data on patients at Hospital A who had invasive mucormycosis during January 2017\u2013June 2021 and calculated annual incidence of HCM (defined as mucormycosis diagnosed within \u22657 days after hospital admission). We performed targeted environmental assessments, including linen sampling at the hospital, to identify potential sources of infection.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>During the outbreak period (June 2019\u2013June 2021), 16 patients had HCM; clinical features were similar between HCM patients and non-HCM patients. Hospital-wide HCM incidence (per 100 000 patient-days) increased from 0 in 2018 to 3 in 2019 and 6 in 2020. For the 16 HCM patients, the most common underlying medical conditions were hematologic malignancy (56%) and recent traumatic injury (38%); 38% of HCM patients died in-hospital. Healthcare-associated mucormycosis cases were not epidemiologically linked by common procedures, products, units, or rooms. At Hospital A and its contracted offsite laundry provider, suboptimal handling of laundered linens and inadequate environmental controls to prevent mucormycete contamination were observed. We detected Rhizopus on 9 (9%) of 98 linens sampled at the hospital, including on linens that had just arrived from the laundry facility.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We describe the largest, single-center, HCM outbreak reported to date. Our findings underscore the importance of hospital-based monitoring for HCM and increased attention to the safe handling of laundered linens.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofac510","type":"journal-article","created":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T04:51:13Z","timestamp":1665982273000},"source":"Crossref","is-referenced-by-count":9,"title":["Investigation of a Prolonged and Large Outbreak of Healthcare-Associated Mucormycosis Cases in an Acute Care Hospital\u2014Arkansas, June 2019\u2013May 2021"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7834-866X","authenticated-orcid":false,"given":"Alexander","family":"Jordan","sequence":"first","affiliation":[{"name":"Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison E","family":"James","sequence":"additional","affiliation":[{"name":"Epidemic Intelligence Service, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"},{"name":"Arkansas Department of Health , Little Rock, Arkansas , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy A W","family":"Gold","sequence":"additional","affiliation":[{"name":"Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"},{"name":"Epidemic Intelligence Service, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Wu","sequence":"additional","affiliation":[{"name":"Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"},{"name":"Epidemic Intelligence Service, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Glowicz","sequence":"additional","affiliation":[{"name":"Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frankie","family":"Wolfe","sequence":"additional","affiliation":[{"name":"Medical Center, University of Arkansas for Medical Sciences , Little Rock, Arkansas , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keyur","family":"Vyas","sequence":"additional","affiliation":[{"name":"Medical Center, University of Arkansas for Medical Sciences , Little Rock, Arkansas , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Litvintseva","sequence":"additional","affiliation":[{"name":"Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lalitha","family":"Gade","sequence":"additional","affiliation":[{"name":"Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazel","family":"Liverett","sequence":"additional","affiliation":[{"name":"Medical Center, University of Arkansas for Medical Sciences , Little Rock, Arkansas , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Alverson","sequence":"additional","affiliation":[{"name":"Medical Center, University of Arkansas for Medical Sciences , Little Rock, Arkansas , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Burgess","sequence":"additional","affiliation":[{"name":"Medical Center, University of Arkansas for Medical Sciences , Little Rock, Arkansas , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Wilson","sequence":"additional","affiliation":[{"name":"Medical Center, University of Arkansas for Medical Sciences , Little Rock, Arkansas , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruoran","family":"Li","sequence":"additional","affiliation":[{"name":"Epidemic Intelligence Service, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"},{"name":"Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"Benowitz","sequence":"additional","affiliation":[{"name":"Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trent","family":"Gulley","sequence":"additional","affiliation":[{"name":"Arkansas Department of Health , Little Rock, Arkansas , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naveen","family":"Patil","sequence":"additional","affiliation":[{"name":"Arkansas Department of Health , Little Rock, Arkansas , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohan","family":"Chakravorty","sequence":"additional","affiliation":[{"name":"Arkansas Department of Health , Little Rock, Arkansas , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winston","family":"Chu","sequence":"additional","affiliation":[{"name":"Arkansas Department of Health , Little Rock, Arkansas , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atul","family":"Kothari","sequence":"additional","affiliation":[{"name":"Arkansas Department of Health , Little Rock, Arkansas , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan R","family":"Jackson","sequence":"additional","affiliation":[{"name":"Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelley","family":"Garner","sequence":"additional","affiliation":[{"name":"Arkansas Department of Health , Little Rock, Arkansas , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuru","family":"Toda","sequence":"additional","affiliation":[{"name":"Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,10,17]]},"reference":[{"key":"2022102620090671100_ofac510-B1","doi-asserted-by":"publisher","first-page":"e405","DOI":"10.1016\/S1473-3099(19)30312-3","article-title":"Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium","volume":"19","author":"Cornely","year":"2019","journal-title":"Lancet Infect Dis"},{"issue":"Suppl 1","key":"2022102620090671100_ofac510-B2","doi-asserted-by":"publisher","first-page":"S16","DOI":"10.1093\/cid\/cir865","article-title":"Pathogenesis of mucormycosis","volume":"54","author":"Ibrahim","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2022102620090671100_ofac510-B3","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1086\/432579","article-title":"Epidemiology and outcome of zygomycosis: a review of 929 reported cases","volume":"41","author":"Roden","year":"2005","journal-title":"Clin Infect Dis"},{"key":"2022102620090671100_ofac510-B4","doi-asserted-by":"publisher","first-page":"69","DOI":"10.3390\/jof5030069","article-title":"A guide to investigating suspected outbreaks of mucormycosis in healthcare","volume":"5","author":"Hartnett","year":"2019","journal-title":"J Fungi (Basel)"},{"issue":"Suppl 1","key":"2022102620090671100_ofac510-B5","doi-asserted-by":"publisher","first-page":"S44","DOI":"10.1093\/cid\/cir867","article-title":"Healthcare-associated mucormycosis","volume":"54","author":"Rammaert","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2022102620090671100_ofac510-B6","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1097\/INF.0000000000000261","article-title":"Mucormycosis outbreak associated with hospital linens","volume":"33","author":"Duffy","year":"2014","journal-title":"Pediatr Infect Dis J"},{"key":"2022102620090671100_ofac510-B7","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.1017\/ice.2016.157","article-title":"Invasive cutaneous rhizopus infections in an immunocompromised patient population associated with hospital laundry carts","volume":"37","author":"Teal","year":"2016","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2022102620090671100_ofac510-B8","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1093\/cid\/civ1006","article-title":"Hospital outbreak of pulmonary and cutaneous zygomycosis due to contaminated linen items from substandard laundry","volume":"62","author":"Cheng","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"Suppl 1","key":"2022102620090671100_ofac510-B9","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1093\/ofid\/ofv133.336","article-title":"Determining the incubation time of mucormycosis: a systematic review","volume":"2","author":"Smith","year":"2015","journal-title":"Open Forum Infect Dis"},{"key":"2022102620090671100_ofac510-B10","author":"Centers for Disease Control and Prevention"},{"key":"2022102620090671100_ofac510-B11","doi-asserted-by":"publisher","first-page":"3138","DOI":"10.1128\/JCM.01070-09","article-title":"Molecular identification of Aspergillus species collected for the transplant-associated infection surveillance network","volume":"47","author":"Balajee","year":"2009","journal-title":"J Clin Microbiol"},{"key":"2022102620090671100_ofac510-B12","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1111\/myc.13249","article-title":"Performance evaluation of fungal DNA PCR amplification from formalin-fixed paraffin-embedded tissue for diagnosis: experience of a tertiary reference laboratory","volume":"64","author":"Lysen","year":"2021","journal-title":"Mycoses"},{"key":"2022102620090671100_ofac510-B13","doi-asserted-by":"publisher","DOI":"10.1099\/mgen.0.000473","article-title":"Genetic diversity of clinical and environmental mucorales isolates obtained from an investigation of mucormycosis cases among solid organ transplant recipients","volume":"6","author":"Nguyen","year":"2020","journal-title":"Microb Genom"},{"key":"2022102620090671100_ofac510-B14","doi-asserted-by":"publisher","first-page":"937","DOI":"10.3201\/eid2605.191045","article-title":"Rhizopus microsporus infections associated with surgical procedures, Argentina, 2006\u20132014","volume":"26","author":"Bowers","year":"2020","journal-title":"Emerg Infect Dis"},{"key":"2022102620090671100_ofac510-B15","author":"American Society of Heating, Refrigerating, and Air-Conditioning Engineers","year":"2021"},{"issue":"Suppl 1","key":"2022102620090671100_ofac510-B16","doi-asserted-by":"publisher","first-page":"S23","DOI":"10.1093\/cid\/cir866","article-title":"Epidemiology and clinical manifestations of mucormycosis","volume":"54","author":"Petrikkos","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2022102620090671100_ofac510-B17","doi-asserted-by":"publisher","first-page":"850","DOI":"10.1093\/cid\/ciy669","article-title":"How clean is the linen at my hospital? The mucorales on unclean linen discovery study of large United States transplant and cancer centers","volume":"68","author":"Sundermann","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2022102620090671100_ofac510-B18","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/cid\/ciw326","article-title":"Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America","volume":"63","author":"Patterson","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2022102620090671100_ofac510-B19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1017\/ice.2021.285","article-title":"Surveillance practices and air-sampling strategies to address healthcare-associated invasive mold infections in Society for Healthcare Epidemiology of America (SHEA) Research Network hospitals-United States, 2020","author":"Gold","year":"2021","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2022102620090671100_ofac510-B20","first-page":"1","article-title":"Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the healthcare infection control practices advisory committee (HICPAC)","volume":"52","author":"Sehulster","year":"2003","journal-title":"MMWR Recomm Rep"},{"key":"2022102620090671100_ofac510-B21","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.1016\/j.ajic.2022.06.026","article-title":"Keeping health care linens clean: underrecognized hazards and critical control points to avoid contamination of laundered health care textiles","volume":"50","author":"Glowicz","year":"2022","journal-title":"Am J Infect Control"},{"key":"2022102620090671100_ofac510-B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2022.07.017","article-title":"Incorporating structured linen oversight into an Infection Prevention program","author":"Sanders","year":"2022","journal-title":"Am J Infect Control"},{"key":"2022102620090671100_ofac510-B23","doi-asserted-by":"publisher","first-page":"2547","DOI":"10.1001\/jama.2016.16477","article-title":"Prevalence of immunosuppression among US adults, 2013","volume":"316","author":"Harpaz","year":"2016","journal-title":"JAMA"},{"key":"2022102620090671100_ofac510-B24","doi-asserted-by":"publisher","first-page":"1452","DOI":"10.1111\/myc.13338","article-title":"COVID-19-associated mucormycosis: an updated systematic review of literature","volume":"64","author":"Pal","year":"2021","journal-title":"Mycoses"},{"key":"2022102620090671100_ofac510-B25","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciac489","article-title":"Increased deaths from fungal infections during the COVID-19 pandemic-National Vital Statistics System, United States, January 2020-December 2021","author":"Gold","year":"2022","journal-title":"Clin Infect Dis"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofac510\/46541084\/ofac510.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/9\/10\/ofac510\/46648954\/ofac510.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/9\/10\/ofac510\/46648954\/ofac510.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T20:09:33Z","timestamp":1666814973000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofac510\/6761764"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,1]]},"references-count":25,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2022,10,5]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofac510","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,10,1]]},"published":{"date-parts":[[2022,10,1]]},"article-number":"ofac510"}}