Becker's Clinical Quality & Infection Control

15 PATIENT SAFETY & OUTCOMES CDC urges clinicians to be vigilant about COVID-19-related fungal infection By Gabrielle Masson F rom Sept. 17-24, nine patients in Arkan- sas had mucormycosis, a sometimes fatal fungal infection, following a COVID-19 diagnosis, the CDC reported Dec. 16. In September 2021, three clinicians inde- pendently alerted the Arkansas Department of Health of multiple patients with mucormy- cosis aer a recent diagnosis of COVID-19. Mucormycosis is an uncommon but severe invasive infection caused by mold. Mucormycosis typically affects people with immunocompromising conditions. The emergence of COVID-19-associated mucormycosis has been reported in other countries, particularly in India, but is infrequently seen in the U.S. COVID-19 may increase mucormycosis risk because of COVID-19-induced immune dysregu- lation or associated treatments that impair host defenses. Cases were considered COVID-19-as- sociated if the patient tested positive for COVID-19 during the 60 days before mu- cormycosis diagnosis. Ten COVID-19-associated mucormycosis cases occurring July 12 to Sept. 28, 2021, were reported to the health department by six hospitals. Nine patients lived in Arkansas, and one lived in a nearby state. Median patient age was 57 years, with ages ranging from 17 to 78. All patients were non-Hispanic white, seven were male, one had a history of solid organ transplan- tation, and one had a recent traumatic injury at the body site where mucormyco- sis later developed. Eight patients had dia- betes. None of the patients was vaccinated against COVID-19. e median interval from COVID-19 diag- nosis to mucormycosis was 18.5 days. Mucormycosis clinical signs and symptoms included those that were rhino-orbital (four patients), pulmonary (three), disseminated (two), and gastrointestinal (one). COVID-19 treatment included supplemental oxygen therapy (eight patients), invasive mechanical ventilation (five), corticosteroids (nine), tocilizumab (two), and baricitinib (two). Five patients received surgical treatment to remove affected tissue. During hospitaliza- tion, three patients with diabetes experi- enced diabetic ketoacidosis. Six of the 10 patients died. Because of the infection's severity, the CDC is urging clinicians to maintain a high index of suspicion for COVID-19-associated mu- cormycosis, including in patients without im- munocompromising conditions. Treatment guidelines recommend prompt antifungal therapy and surgical intervention. n Unvaccinated people 14 times more likely to die from COVID-19, CDC says By Mackenzie Bean U nvaccinated adults are nearly six times more likely to test positive for COVID-19 and 14 times more likely to die from the virus compared to vaccinated individuals, accord- ing to CDC data. The data, posted Nov. 22, reflects COVID-19 cases and deaths reported in 24 U.S. jurisdictions between April 4 and Oct. 2. The CDC found unvaccinated individuals in all age groups had higher case and death rates than fully vaccinated people. For example, the COVID-19 case rate for vaccinated adults ages 65-79 was 90.11 per 100,000, compared to 589.04 for unvaccinated adults in the same age range. The updated data comes after a September report from the CDC, using data from the spring and summer, found unvaccinated people were 10 times more likely to be hospitalized and 11 times more likely to die from the disease. n COVID-19 linked to higher risk of stillbirth, CDC finds By Mackenzie Bean P regnant women who contract COVID-19 may be at an increased risk for stillbirth compared to women without the infection, a Nov. 19 CDC report found. CDC researchers analyzed data on more than 1.2 million deliver- ies in the U.S. between March 2020 and September 2021. They analyzed stillbirth rates before and after the highly infectious delta variant became the dominant coronavirus strain in the U.S. Overall, stillbirths were rare and similar to levels seen before the pandemic. Just 0.64 percent of deliveries involving women without COVID-19 resulted in stillbirths, close to the prepandemic stillborn rate of 0.59 percent. Among pregnant women with COVID-19, however, the stillbirth rate was slightly higher at 0.98 percent. Once the delta variant became dominant in the U.S. in July, the stillborn rate among women with the virus jumped to 2.7 percent. The analysis "demonstrates that the risk has increased during the delta period," but more research is needed to "identify the biologic mecha- nism for the observed increased risk for stillbirth," the CDC said. "Implementing evidence-based COVID-19 prevention strategies, including vaccination before or during pregnancy, is critical to re- duce the impact of COVID-19 on stillbirths," the agency added. n

• Cover