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Malani, Anurag N; Kauffman, Carol A; Latham, Robert; Peglow, Sheree; Ledtke, Christopher S; Kerkering, Thomas M; Kaufman, David H; Triplett, Patricia F; Wright, Patty W; Bloch, Karen C; McCotter, Orion; Toda, Mitsuru; Jackson, Brendan R; Pappas, Peter G; Chiller, Tom M

Long-term Outcomes of Patients With Fungal Infections Associated With Contaminated Methylprednisolone Injections

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  • Medientyp: E-Artikel
  • Titel: Long-term Outcomes of Patients With Fungal Infections Associated With Contaminated Methylprednisolone Injections
  • Beteiligte: Malani, Anurag N; Kauffman, Carol A; Latham, Robert; Peglow, Sheree; Ledtke, Christopher S; Kerkering, Thomas M; Kaufman, David H; Triplett, Patricia F; Wright, Patty W; Bloch, Karen C; McCotter, Orion; Toda, Mitsuru; Jackson, Brendan R; Pappas, Peter G; Chiller, Tom M
  • Erschienen: Oxford University Press (OUP), 2020
  • Erschienen in: Open Forum Infectious Diseases, 7 (2020) 6
  • Sprache: Englisch
  • DOI: 10.1093/ofid/ofaa164
  • ISSN: 2328-8957
  • Schlagwörter: Infectious Diseases ; Oncology
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: Abstract Background The largest health care–associated infection outbreak in the United States occurred during 2012–2013. Following injection of contaminated methylprednisolone, 753 patients developed infection with a dematiaceous mold, Exserohilum rostratum. The long-term outcomes of these infections have not been described. Methods This retrospective cohort study of 440 of a total of 753 patients with proven or probable Exserohilum infection evaluated clinical and radiographic findings, antifungal therapy and associated adverse effects, and outcomes at 6 weeks, 3, 6, 9, and 12 months after diagnosis. Patients were grouped into 4 disease categories: meningitis with/without stroke, spinal or paraspinal infections, meningitis/stroke plus spinal/paraspinal infections, and osteoarticular infections. Results Among the 440 patients, 223 (51%) had spinal/paraspinal infection, 82 (19%) meningitis/stroke, 123 (28%) both, and 12 (3%) osteoarticular infection. Of 82 patients with meningitis/stroke, 18 (22%) died; among those surviving, 87% were cured at 12 months. Only 7 (3%) of 223 patients with spinal/paraspinal infection died, but at 12 months, 68% had persistent or worsening pain and only 47% were cured. For the 123 patients with both meningitis/stroke and spinal/paraspinal infection, 10 (8%) died, pain persisted in 72%, and 52% were cured at 12 months. Only 37% of those with osteoarticular infection were cured at 12 months. Adverse events from antifungal therapy were noted at 6 weeks in 71% of patients on voriconazole and 81% on amphotericin B. Conclusions Fungal infections related to contaminated methylprednisolone injections culminated in death in 8% of patients. Persistent pain and disability were seen at 12 months in most patients with spinal/paraspinal infections.
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