UPMC says mold cases fall within norm

The type of fungal infections that caused UPMC to halt its transplant program occur annually in 1 to 7 percent of transplant patients worldwide, officials said Wednesday.

UPMC revealed the information in the midst of a mold outbreak after poring through research literature and consulting experts at a dozen of the top American and international transplant centers.

“That means these recent cases are not outside the norm, but UPMC decided to investigate anyway,” spokeswoman Allison Hydzik said.

About 1,300 patients are registered on the wait list at UPMC, one of the busiest transplant centers in the world, which performs about 400 transplants a year. The outbreak prompted the transplant program's temporary closure Monday. Officials have not said when it will reopen.

Hospital safety expert Lawrence Muscarella said he was disappointed in UPMC's explanation that the cases were normal.

“Citing statistics that show these types of fungal infections occur in 1 to 7 percent of patients worldwide belies UPMC's commitment to quality,” said Muscarella, a Philadelphia-based biomedical engineer who specializes in infection control. “It also is a distraction, inconsistent with the principles of safety and enhanced health care quality, and appears to downplay this deadly outbreak's significance.”

Four patients contracted mold infections during the past year in UPMC Presbyterian and UPMC Montefiore. Three of those patients died, the most recent on Sept. 17, although UPMC doctors have said their deaths cannot be directly attributed to the infections. A fourth patient, who had a lung transplant, has a mold infection and remains hospitalized.

The federal Centers for Disease Control and Prevention and Pennsylvania Department of Health representatives are assisting UPMC in investigating the mold source.

Initially, Steven Shapiro, UPMC's chief medical and scientific officer, said he expected transplant postponement to be resolved in “two to three days.” However, Thursday marks the fourth day of suspended transplants for the health care giant.

“I think they did exactly what they thought was in the best interests of their patients and their program, and I support their decision to close the transplant program,” said Susan Stuart, president and CEO of the Center for Organ Recovery and Education in O'Hara. “Any way we can help them through this we are happy to do so.”

CORE's campus houses a $10 million addition with operating rooms where organ donors could be taken during the closure, she said.

UPMC doctors noted in the past week that UPMC accepts transplant patients who are seriously ill and have severely compromised immune systems, leaving them susceptible to bacterial and fungal infections. Hydzik quantified that information Wednesday, explaining 30 to 40 percent of lung transplants handled by UPMC are in patients that other transplant centers refuse to treat.

“UPMC does these transplants in the sickest of the sick — and those are the people most sensitive to contracting this kind of fungal infection,” Hydzik said.

Muscarella countered that tolerance for infections must be zero.

“A hospital treating the sickest of patients cannot make excuses for infections,” he said. “Rather, it must be more committed, and allocate even more resources, to prevent them.”

UPMC has deployed disinfecting robots that use ultraviolet light to sanitize hospital operating and patient rooms and replaced microfilters in all air handling units. The hospital system is rechecking air seals around windows and doors and sealing laundered linens in plastic for patients with compromised immune systems.

UPMC identified the types of mold detected as rhizomucor, lichtheimia and rhizopus, part of a group of molds known as mucor. Tests that came back Wednesday for a liver transplant patient, who died Sept. 17 in Montefiore, indicated the patient picked up a lichtheimia fungal infection, Hydzik said.

The heart transplant patient who died in October at Presby had lichtheimia. Another heart transplant patient who died in June at Presby had rhizomucor, and the fourth infected patient, who is in guarded condition at Presby, has rhizopus.

The health care giant said it has prescribed a brand of antifungals called Cresemba as a precaution to 11 recent Presby transplant patients.

Hydzik said UPMC administrators remained optimistic about the final results of the investigation.

“What we find will be shared with our peers internationally and could change the standard of care worldwide,” she said.

Ben Schmitt is a staff writer for Trib Total Media. He can be reached at 412-320-7991 or bschmitt@tribweb.com.