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Long-term Outcomes of Patients With Fungal Infections Associated With Contaminated Methylprednisolone Injections
Anurag N Malani1, Carol A Kauffman2, Robert Latham3
1St Joseph Mercy Hospital, Ann Arbor, Michigan, USA.
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.
Insights
Long-term outcomes of fungal infections from contaminated methylprednisolone injections show significant mortality and persistent pain. Most patients with spinal infections experienced chronic pain and disability one year post-diagnosis.
Area of Science:
- Infectious Diseases
- Mycology
- Public Health
Background:
- The 2012-2013 US healthcare-associated infection outbreak involved 753 patients infected with Exserohilum rostratum following contaminated methylprednisolone injections.
- Long-term outcomes for these Exserohilum rostratum infections remain largely undescribed.
Purpose of the Study:
- To evaluate the long-term clinical and radiographic findings, treatment outcomes, and adverse effects of antifungal therapies in patients infected with Exserohilum rostratum.
- To categorize patient outcomes based on infection type: meningitis with/without stroke, spinal/paraspinal infections, combined meningitis/stroke and spinal/paraspinal infections, and osteoarticular infections.
Main Methods:
- Retrospective cohort study of 440 out of 753 patients with confirmed or probable Exserohilum infection.
- Assessment of clinical and radiographic data, antifungal treatments, and adverse events at multiple time points up to 12 months post-diagnosis.
- Categorization of patients into four distinct disease groups for outcome analysis.
Main Results:
- Spinal/paraspinal infections were most common (51%), followed by combined meningitis/stroke and spinal/paraspinal infections (28%).
- Mortality rates varied by infection type: 22% for meningitis/stroke, 3% for spinal/paraspinal, 8% for combined, and unspecified for osteoarticular.
- At 12 months, significant sequelae included persistent pain (68% spinal, 72% combined) and lower cure rates (47% spinal, 52% combined, 37% osteoarticular).
- High rates of adverse events were reported for antifungal therapies: 71% for voriconazole and 81% for amphotericin B.
Conclusions:
- Fungal infections from contaminated methylprednisolone injections resulted in an 8% mortality rate.
- Persistent pain and disability were prevalent at 12 months, particularly in patients with spinal/paraspinal infections.
- Antifungal treatments were associated with substantial adverse events.
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