UPMC: Mold outbreak spreads to another hospital, 3rd patient dies
BYBEN SCHMITT|Friday, Sept. 18, 2015, 6:26p.m.
A rare mold outbreak at UPMC Presbyterian has surfaced at an adjacent hospital, where the death of a liver transplant patient became the third tied to the fungal infections, UPMC's chief medical officer said Friday.
The patient died Thursday night in UPMC Montefiore — a different location from two prior deaths of patients with similar infections. Those two patients, and another who remains hospitalized, had been treated in the same room of a now-shuttered cardiothoracic intensive care unit at Presby, next door to Montefiore.
“This obviously says there was more to it than just a single room,” UPMC chief medical and scientific officer Steven Shapiro told the Tribune-Review. “We're testing everything: the air, the linens, the equipment. We are looking at all possibilities.”
The development prompted UPMC to place all organ transplant recipients at UPMC Presbyterian and Montefiore on new antifungal medications as a precaution. UPMC operates one of the busiest transplant programs in the country, with about 400 surgeries performed every year.
“We are doubling down on our efforts to understand the situation and to protect our patients,” Dr. Shapiro said. “This prophylactic treatment is intended to protect them until we find and fix the source of this problem.”
Shapiro said about 24 transplant patients are on the antifungal medication.
“We're confident this will protect them,” he said.
Officials are looking at several potential sources for the mold, including toilets within Presby. An initial examination found mold behind a wall in the room where the three Presby patients were treated.
Neither hospital has any transplants scheduled this weekend. UPMC plans to evaluate possible further precautions Monday, such as whether to halt transplants temporarily, he said.
UPMC workers deployed disinfecting robots that use ultraviolet light to sanitize hospital operating and patient rooms and began replacing microfilters in all air handling units. The health care system said it is consulting with mold and hospital environment specialist Andrew Streifel, who works at the University of Minnesota.
The mold incidents date to October, when doctors discovered a fungal infection on the left leg of a heart transplant patient.
In June, doctors discovered a different form of mold on the buttocks of another heart transplant patient, officials said. Those patients died, but officials said their complex conditions make it difficult to attribute the deaths to the mold.
A third Presby patient, who is male and had a lung transplant, remains hospitalized with a mold infection on his lung tissue and other ailments.
“I saw him this afternoon,” Shapiro said Friday. “He is hanging in there. These types of infections are very life-threatening.”
After the diagnosis of the third patient, a physician recalled the mold cases in June and October, according to UPMC.
Presby administrators ordered the relocation of all ICU patients Sept. 8, five days after doctors diagnosed the lung transplant patient with a mold infection. The unit typically handles patients with heart and lung diseases who are admitted for heart procedures or transplants.
The Trib first reported the shutdown of Presby's ICU and relocation of 18 patients.
The liver transplant patient who died in Montefiore had a skin rash that appeared to be fungal, Shapiro said.
“Preliminary testing indicates that this infection is consistent with that in the three previous patients,” he said.
UPMC identified the types of mold detected as rhizomucorm, lichtheimia and rhizopus.
These fungi are typically found in the soil and in association with decaying organic matter, such as leaves, compost piles or rotten wood, according to the federal Centers for Disease Control and Prevention.
The CDC confirmed Friday that the state Department of Health called its office late this week to ask for assistance in the investigation.
Dr. Mary Brandt, the CDC's Mycotic Diseases Branch chief, said the office's level of involvement could range from phone consultations to on-site assistance.
“Usually, in these types of cases, the state defines what they would like us to do for them or with them,” Brandt said. “It all depends on what they need. We are just at the beginning.”
Both UPMC Presby and UPMC Montefiore are in Oakland.
“This is a situation that we take extremely seriously,” Shapiro said. “We are exploring all avenues suggested by our UPMC experts and outside experts.”
Officials emphasized that the mold outbreak does not pose a threat to healthy visitors and staffers.