Impact of environmental measures to control a Fusarium outbreak at a cancer center.

Abstract

BACKGROUND: Currently, fusariosis has been considered the second most common mold infection in immunosuppressed patients, which usually develops into invasive and disseminated forms with high mortality. The presence of pathogenic Fusarium species has been identified in water supply systems, which have been identified as possible sources of cases and outbreaks. Environmental measures have been proposed as an essential action to reduce the incidence of this infection in immunosuppressed patients, especially those with hematological malignancies. The effectiveness of these specific environmental measures should be continuously assessed.OBJECTIVES: This study aims to assess the impact of environmental measures to control a Fusarium spp. outbreak at a cancer center, define clinical characteristics of Fusarium spp. cases during the study period and detect clonality of Fusarium strains isolated in clinical samples, as well as the correlation with Fusarium strains isolated from the environment.METHOD: Quasi-experimental (pre-and post-intervention), epidemiological, retrospective study to assess the impact of the implementation of environmental measures to control a Fusarium spp. outbreak at the Cancer Institute of the State of São Paulo (ICESP). The casuistry will be composed of all individuals with any positive clinical culture for Fusarium spp. during the study period. Epidemiological data will be obtained from patient electronic records (Tasy®). The following outcomes will be evaluated: colonization, infection and mortality associated with Fusarium spp. The intervention to be assessed will be the set of environmental measures, including water quality control, adopted for the outbreak control. Clinical strains will be provided from the Central Laboratory Division of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (DLC-HCFMUSP) and the environmental samples will be obtained by Adolfo Lutz Institute (IAL) Mycology Center. The IAL Mycology Center will conduct the storage and the processing of the strains for identification of Fusarium species and clonality analysis, by means of phenotypic characterization, molecular methods, as well as the determination of the susceptibility profile to antifungals. (AU)