Four organ transplant patients who contracted fungal infections following surgeries at two University of Pittsburgh hospitals didn't acquire the infections in the same manner.
The Centers for Disease Control and Prevention spent 16 days determining the source of the infections, which occurred in patients who had transplant surgeries at UPMC Presbyterian and UPMC Montefiore between the summer of 2014 and early 2015. Each patient was infected by a species of zygomycota.
The investigation revealed that two of the patients got the infections by breathing in mold spores. Another experienced a skin infection while the fourth contracted the infection from an outside source, but the origin is not known.
Three of the patients have died, and the fourth remains hospitalized. Two of the patients who died received a heart transplant; the third received a liver transplant. A patient who received the double lung transplant is still alive, according to the Pittsburgh Post-Gazette.
The CDC did not reveal how each patient was infected, but the Post-Gazette reported that the double lung transplant patient acquired the infection through the surgical wound. One of the heart transplant patients had a "disseminated" infection of indeterminate origin. The liver and other heart transplant patients breathed in mold spores that led to infections.
In early September, UPMC shut down its cardio thoracic intensive care unit at Presbyterian when three transplant patients were discovered to have similar fungal infections. Several days later, the liver transplant patient was found to have a fungal infection as well. UPMC's liver transplant program is housed at Montefiore Medical Center.
On Sept. 21, UPMC voluntarily shut down its adult transplant program and started its own investigation into the mold infection "cluster." However, the 21-hospital system was unable to identify the infection source, and the CDC was contacted to assist. Even so, UPMC resumed transplants Sept. 27. At that point, UPMC said it would:
- Conduct mold remediation in the cardio thoracic intensive care unit
- Provide vulnerable patients with medication to protect from mold spores
- Use ultraviolet radiation robots to kill mold in the hospitals
- Replace microfilters in air-handling units
- Keep linen wrapped in plastic until it reached the intensive care units
The CDD responded to the medical centers about a week before transplants resumed. During the investigation, the CDC's team took about 30 environmental samples inside both hospitals. Samples were taken from multiple sources including floors and baseboards, ceiling tiles, air ducts and vents, air filters, carpets and vacuum cleaners. Air samples were collected as well as samples of the soil near the facilities.
Epidemiologists reviewed the entire charts of some 125 patients who had been in the transplant units in both Montefiore and Presbyterian between June 2014 and September 2015. The team also reviewed hundreds of patient charts going back to 2011, but did not say if new fungal infections had been identified.
Samples of the isolated molds from three of four patients were also collected. The fungus from the first patient who was found to have the infection could not be isolated. Medication she had taken kill the infection likely damaged the fungus, officials said.
Scientists in Atlanta, where the CDC is based, will attempt to grow fungi from surface, soil and air samples collected in Pittsburgh to determine if they can link the samples to the any of the patients.
