Major article Surveillance of patients identified with fungal mold at a public academic medical center Priti Patwari MD a , James Cutrell MD a , Archana Bhaskaran MD b , Sylvia Trevino MT c , Pranavi Sreeramoju MD, MPH a, c, * a Department of Medicine-Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX b Division of Infectious Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada c Department of Infection Prevention, Parkland Health and Hospital System, Dallas, TX Key Words: Health careeassociated infection Mold infection Fungal infection Infection control Background: This study describes the epidemiology of patients with fungal mold infection or coloni- zation at a large academic medical center during a period of ongoing construction of a new hospital building. Methods: This is an observational retrospective cohort study performed at a public academic hospital. We performed focused medical record review of all patients with fungal mold isolated on microbiologic culture over a 3-year period from May 2009 through April 2012. We established case definitions by modifying criteria used in previously published studies. We established 4 categories for invasiveness: proven invasive fungal disease (IFD), probable IFD, clinical infection not meeting IFD criteria, or colo- nization/contamination. We also established 3 categories for association with our health care facilities: health careeassociated hospital onset (HO), health careeassociated community onset (HACO), or com- munity associated (CA). Results: Of the 188 cases included in the study, 15 (7.9%) and 23 (12.2%) met criteria for proven and probable IFD, respectively. Of the cases, 114 (60.6%) represented contamination or colonization, and 36 (19.1%) had clinical infection not meeting IFD criteria. Epidemiologically, 46 (24.5%) cases were HO, 42 (22.3%) cases were HACO, and 100 (53.2%) cases were CA. Conclusion: The surveillance methods we established were helpful for characterizing and monitoring fungal mold infections at the study institution. Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. INTRODUCTION Opportunistic fungal infections are a rising threat in increasingly immunocompromised and critically ill patients. 1 Although invasive fungal disease (IFD) attributed to Candida or Aspergillus species predominates, the incidence of infections from dematiaceous molds and zygomycetes is increasing. 1,2 Because these molds are ubiqui- tous in the environment, there is concern during construction ac- tivities for infection or colonization in immunocompromised hosts, including patients with hematologic malignancies, hematopoietic stem cell and solid organ transplants, human immunodeficiency virus, and burns. 3 Fungal infections can lead to increased long-term sequelae and mortality in these vulnerable populations. 4 Data on the incidence of fungal mold infections outside of the context of outbreaks or immunocompromised patients are scant. The objective of this study was to describe the epidemiology of patients identified with fungal mold on microbiologic cultures at a large academic medical center. The context in which this study was undertaken was massive ongoing construction activity across the street from where our hospital facilities are located. Additional information regarding the construction is available on the Parkland Memorial Hospital website (http://newparkland.parklandhospital.com/). METHODS We performed a retrospective observational cohort study at Parkland Memorial Hospital, Dallas, TX. It is an 809-bed public academic tertiary hospital with services, including a level I trauma center, level III neonatal intensive care unit, regional burn unit, renal transplantation, and high-risk obstetrics. Physician services * Address correspondence to Pranavi Sreeramoju, MD, MPH, 5323 Harry Hines Blvd, MC 9113, Dallas, TX 75390-9113. E-mail address: pranavi.sreeramoju@utsouthwestern.edu (P. Sreeramoju). Presented at IDWeek, October 20, 2012, San Diego, CA. Conflict of interest: None to report. Contents lists available at ScienceDirect American Journal of Infection Control journal homepage: www.ajicjournal.org American Journal of Infection Control 0196-6553/$36.00 - Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2014.03.025 American Journal of Infection Control xxx (2014) 1-5