Trends in Hospitalizations Related to Invasive Aspergillosis and Mucormycosis in the United States, 2000–2013


Snigdha Vallabhaneni, Kaitlin Benedict, Gordana Derado and Rajal K. Mody.
Open Forum Infectious Diseases


Background. Invasive aspergillosis (IA) and mucormycosis contribute to substantial mortality, especially among immunocom- promised persons, including those with hematopoietic stem cell transplant (HSCT), hematologic malignancy (HM), and solid organ transplant (SOT).

Methods. Using International Classification of Diseases, Ninth Revision codes available in the National Inpatient Sample, a hos- pital discharge database, we estimated IA-related hospitalizations (IA-RH), mucormycosis-RH (M-RH), HSCT-RH, HM-RH, and SOT-RH during 2000–2013. United States census data were used to calculate overall M-RH and IA-RH rates and present trends; esti- mated annual numbers of HSCT-RH, HM-RH, and SOT-RH served as denominators to calculate M-RH and IA-RH rates occurring with these conditions. Weighted least-squares technique was used to test for linear trends and calculate average annual percentage change (APC).

Results. There were an estimated 169 110 IA-RH and 9966 M-RH during 2000–2013. Overall, IA-RH and M-RH rates per mil- lion persons rose from 32.8 to 46.0 (APC = +2.9; P < .001) and 1.7 to 3.4 (APC = +5.2%; P < .001), respectively, from 2000 to 2013. Among HSCT-RH, there was no significant change in M-RH rate, but a significant decline occurred in IA-RH rate (APC = −4.6%; P = .004). Among HM-RH, the rate of M-RH increased (APC = +7.0%; P < .001), but the IA-RH rate did not change significantly (APC = +1.2%; P = .073). Among SOT-RH, M-RH (APC = +6.3%; P = .038) and IA-RH rates (APC = +4.1%; P < .001) both increased.

Conclusions. Overall IA-RH and M-RH rates increased during 2000–2013, with a doubling of M-RH. Mucormycosis-related hospitalization occurring in conjunction with certain comorbidities increased, whereas IA-RH rates among patients with the comor - bidities, decreased, remained stable, or increased to a lesser extent than M-RH. Keywords. burden; immunocompromised population; invasive aspergillosis; mucormycosis; trends.