398. Review of Mucormycosis Cases at the University of Colorado Hospital From 2012 to 2018 and Evaluation of Risk Factors and Appropriateness of Antifungal Prophylaxis

BACKGROUND: Healthcare associated outbreaks of mucormycosis have been described in the literature. In 2017, the University of Colorado Hospital (UCH) had an increased number of cases of mucormycosis. The objective of this study was to evaluate possible risk factors and weather patterns associated with cases of mucormycosis diagnosed at UCH from 2012 to 2018 in order determine whether the current antifungal prophylaxis used at UCH should be modified. METHODS: A retrospective cohort was conducted involving patients >18 years old who were admitted to UCH between 2012 and 2018 and were diagnosed with proven or probable mucormycosis as defined by the European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG) criteria. Medical records were reviewed, and data were collected on risk factors, antifungal prophylaxis, and mortality outcome. Weather data were collected from the National Centers for Environmental Information (NCEI). RESULTS: Twenty-five cases of proven or probable mucormycosis were identified. On average patients had at least two risk factors associated with mucormycosis. The most common risk factors included diabetes mellitus (DM) (13 patients), hematologic malignancy or hematopoietic stem cell transplant (HSCT) (11 patients), use of immunosuppressing medications (11 patients), and invasive procedures. (9 patients). At the time of diagnosis, only six patients were on an antifungal with mold activity. Eight patients died during hospitalization. The distribution of cases over time was compared with weather data for Colorado. A cluster of cases occurred in 2013 (6 cases) and in 2017 (8 cases). A majority of cases were diagnosed during the summer and fall months with July being the month with the most number of cases. There were higher levels of precipitation that occurred prior to or during the cluster of cases. CONCLUSION: Cases of mucormycosis at UCH were associated with DM, hematologic malignancy/HSCT, use of immunosuppressive therapy, and invasive procedures. The increase of cases seen 2013 and 2017 occurred in the summer and fall months after higher levels of precipitation were observed in Colorado. Providers at UCH may consider modifying antifungal prophylaxis to include mold coverage in patients with >2 risk factors for mucormycosis who are admitted during the summer and fall. DISCLOSURES: M. Barron, Astellas Pharma: Investigator, Research support.