New CDC surveillance data from 2020 to 2024 shows that half of patients with invasive mold infections require mechanical ventilation, with significantly higher mortality observed in those with recent COVID-19.
RT’s Three Key Takeaways:
- Critical Respiratory Support: Half of the patients identified with invasive mold disease required intubation and mechanical ventilation, while 43% were admitted to an intensive care unit (ICU) in the two weeks prior to diagnosis.
- COVID-19 Mortality Link: The 90-day all-cause mortality rate reached 66% for patients with a recent COVID-19 diagnosis, which was significantly higher than the 41% death rate seen in patients without the virus.
- Broadened Risk Factors: Over 35% of cases occurred in patients who did not possess classic host risk factors such as transplants or neutropenia, suggesting that clinical suspicion should extend beyond traditional immunocompromised populations.
USCDC researchers identified invasive mold diseases (IMDs) as severe infections associated with frequent intensive care unit (ICU) admission and high mortality rates, according to a surveillance summary published in the Morbidity and Mortality Weekly Report (MMWR).
The study, which tracked cases across four Atlanta hospitals from 2020 to 2024, found that 50% of patients with IMD required invasive mechanical ventilation. Among the 449 cases identified, pulmonary infections were the most common, accounting for 68% of diagnoses. The 90-day all-cause mortality rate for these patients was 45%.
Impact of COVID-19 on Outcomes
The report highlighted a significant correlation between recent SARS-CoV-2 infection and severe IMD outcomes. Approximately 13% of patients with mold disease had a current or recent COVID-19 diagnosis. These patients experienced higher rates of ICU admission during the two weeks preceding their specimen collection compared to those without COVID-19 (66% vs 39%).
Mortality was also notably higher in the COVID-19 cohort. The 90-day all-cause mortality rate for IMD patients with COVID-19 was 66%, compared to 41% for patients without the virus. The report noted that indicators of severe illness were more common among these patients, emphasizing the role of COVID-19 as a recognized risk factor for severe fungal complications.
Shifting Risk Factors and Patient Demographics
While IMDs primarily affect individuals with immunocompromising conditions, the CDC data showed that 35% of patients did not meet the classic host factors established by the National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group (MSG). These classic factors include a history of neutropenia, hematologic malignancy, or organ transplantation.
The presence of a hematologic malignancy was found in 22% of cases, and 27% of patients had received a solid organ transplant. However, the report stated that surveillance based only on traditional risk factors might miss a substantial proportion of cases. Other conditions more common among IMD patients than those without the disease included cirrhosis, end-stage renal disease, and severe burns.
Pathogen Identification and Treatment Trends
Aspergillus species were the most common fungal taxa identified, appearing in 71% of all IMD cases. Aspergillus fumigatus was the most frequent species, accounting for 21% of the total. Other identified molds included Fusarium species (4%), Mucorales (4%), and Scedosporium species (3%).
Treatment typically involved prolonged therapy with antifungals. Among patients with IMD, 81% received antifungal treatment effective against molds. The most common medication used was isavuconazole (40%), followed by voriconazole (32%), and amphotericin B (21%).
Clinical Implications for Healthcare Settings
Incidence rates varied by facility type. At academic hospitals, the pooled average annual IMD incidence was 4.8 inpatient cases per 100 inpatient beds and 14.0 ICU cases per 100 ICU beds. Community hospitals saw a lower average annual incidence of 2.8 inpatient cases per 100 beds and 10.2 ICU cases per 100 beds, as reported to the National Healthcare Safety Network (NHSN).
The report concluded that healthcare providers should remain vigilant for IMDs as a life-threatening complication in both immunocompromised and critically ill patients. The findings serve as benchmark data to help establish baseline rates for future surveillance and the detection of healthcare-associated outbreaks. Researchers suggested that future efforts should prioritize the implementation of rapid, sensitive diagnostic tests to facilitate earlier disease identification and improve patient outcomes.
