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Hahn T, Cummings KM, Michalek AM, Lipman BJ, Segal BH, McCarthy PL. Efficacy of High-Efficiency Particulate Air Filtration in Preventing Aspergillosis in Immunocompromised Patients With Hematologic Malignancies. Infect Control Hosp Epidemiol 2015; 23:525-31. [PMID: 12269451 DOI: 10.1086/502101] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objectives:To describe and investigate the cause of an outbreak of 10 cases of nosocomial invasive infection withAspergillus flavusin a hematologic oncology patient care unit.Design:A retrospective cohort study.Setting:The hematologic oncology unit of a comprehensive cancer center.Patients:Ninety-one patients admitted to the hematologic oncology service between January 1 and December 31,1992, for 4 or more consecutive days were included in the study.Results:Ten (18%) of 55 patients admitted from July to December 1992 were diagnosed as having invasive aspergillosis compared with 0 (0%) of 36 patients admitted from January to June 1992 to the same patient care units. Patient characteristics, mortality rate, autopsy rate, and admitting location did not change significantly during the course of the year to result in a sudden increase in the number of aspergillosis cases. The source of the outbreak was the high counts ofAspergillusconidia determined from air sampling in the non–bone marrow transplant wing during the outbreak. After high-efficiency particulate air (HEPA) filters were installed as an infection control measure, there were only two additional cases of nosocomial aspergillosis in the 2 years following the outbreak.Conclusions:This outbreak occurred among hematologic oncology patients with prolonged granulocytopenia housed in an environment with neither HEPA filters nor laminar air flow units. Our data demonstrate that in the setting of an outbreak of aspergillosis, HEPA filters are protective for highly immunocompromised patients with hematologic malignancies and are effective at controlling outbreaks due to air contamination withAspergillusconidia.
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Affiliation(s)
- Theresa Hahn
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
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52
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Rocchi S, Reboux G, Larosa F, Scherer E, Daguindeau E, Berceanu A, Deconinck E, Millon L, Bellanger AP. Evaluation of invasive aspergillosis risk of immunocompromised patients alternatively hospitalized in hematology intensive care unit and at home. INDOOR AIR 2014; 24:652-661. [PMID: 24621176 DOI: 10.1111/ina.12108] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 03/06/2014] [Indexed: 06/03/2023]
Abstract
UNLABELLED Contrary to hospital exposure, little is known about the indoor fungal exposure of hematology patients at home. The aim of our study was to investigate the mold exposure of hematology patients both at home and at hospital to assess their invasive aspergillosis (IA) risk. Fungal exposure was assessed by quantifying opportunistic molds at hospital during hospitalization and in homes of 53 hematology patients. IA was diagnosed in 13 of 53 patients and invasive fungal infection (IFI) in one patient. In hospital, no opportunistic species, or low levels of opportunistic species, were found in 98% of weekly controls. Only 2% of hematology intensive care unit (ICU) controls showed a high level of Aspergillus fumigatus spores in corridor air. Five patients IA were hospitalized during these periods. Seven dwellings of 53 (5/14 dwellings of patients with IA/IFI and 2/39 dwellings of non-IA patients) had a percentage of A. fumigatus and Aspergillus flavus to total mold (significant predictor variable of IA/IFI in our study, general linear model, P-value = 0.02) as high as 15%. Maintaining a 'zero Aspergillus' goal at hospital is essential, and establishing specific and individually opportunistic mold monitoring at home could help to further reduce the IA risk through continuous surveillance. PRACTICAL IMPLICATIONS This study emphasizes the fact that preventive measures should not be aimed only at the hospital setting: among patients diagnosed with invasive aspergillosis/invasive fungal infection (IA/IFI), 5 of 14 (36%) were exposed to opportunistic fungal species at home exclusively. Moreover, four of these five patients were living in homes having the highest percentage of Aspergillus fumigatus and Aspergillus flavus (>15%), one of which had 48% of A. fumigatus. Therefore, our work supports the need for a counselor to carry out an environmental survey in patients’ homes.
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Affiliation(s)
- S Rocchi
- Chrono-Environnement UMR 6249 Research Team, Franche-Comté University, Besançon, France
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Crabol Y, Lortholary O. Invasive mold infections in solid organ transplant recipients. SCIENTIFICA 2014; 2014:821969. [PMID: 25525551 PMCID: PMC4261198 DOI: 10.1155/2014/821969] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/03/2014] [Indexed: 05/13/2023]
Abstract
Invasive mold infections represent an increasing source of morbidity and mortality in solid organ transplant recipients. Whereas there is a large literature regarding invasive molds infections in hematopoietic stem cell transplants, data in solid organ transplants are scarcer. In this comprehensive review, we focused on invasive mold infection in the specific population of solid organ transplant. We highlighted epidemiology and specific risk factors for these infections and we assessed the main clinical and imaging findings by fungi and by type of solid organ transplant. Finally, we attempted to summarize the diagnostic strategy for detection of these fungi and tried to give an overview of the current prophylaxis treatments and outcomes of these infections in solid organ transplant recipients.
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Affiliation(s)
- Yoann Crabol
- Université Paris Descartes, Sorbonne Paris Cité, Centre d'Infectiologie Necker Pasteur, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, APHP, 75015 Paris, France
| | - Olivier Lortholary
- Université Paris Descartes, Sorbonne Paris Cité, Centre d'Infectiologie Necker Pasteur, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, APHP, 75015 Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, CNRS URA3012, 75015 Paris, France
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54
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Shepley MM, Song Y. Design Research and the Globalization of Healthcare Environments. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2014; 8:158-98. [DOI: 10.1177/193758671400800112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE: Global healthcare practice has expanded in the past 20 years. At the same time the incorporation of research into the design process has gained prominence as a best practice among architects. The authors of this study investigated the status of design research in a variety of international settings. We intended to answer the question, “how pervasive is healthcare design research outside of the United States?” METHOD: The authors reviewed the international literature on the design of healthcare facilities. More than 500 international studies and conference proceedings were incorporated in this literature review. A team of five research assistants searched multiple databases comparing approximately 16 keywords to geographic location. Some of those keywords included: evidence-based design, salutogenic design, design research, and healthcare environment. Additional articles were gathered by contacting prominent researchers and asking for their personal assessment of local health design research studies. RESULTS: While there are design researchers in most parts of the world, the majority of studies focus on the needs of populations in developed countries and generate guidelines that have significant cost and cultural implications that prohibit their implementation in developing countries. Additionally, the body of literature discussing the role of culture in healthcare environments is extremely limited. CONCLUSION: Design researchers must address the cultural implications of their studies. Additionally, we need to expand our research objectives to address healthcare design in countries that have not been previous considered.
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Niaré-Doumbo S, Normand AC, Diallo YL, Dembelé AK, Thera MA, Diallo D, Piarroux R, Doumbo O, Ranque S. Preliminary study of the fungal ecology at the haematology and medical-oncology ward in Bamako, Mali. Mycopathologia 2014; 178:103-9. [PMID: 24889723 DOI: 10.1007/s11046-014-9760-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 05/13/2014] [Indexed: 12/13/2022]
Abstract
Data on fungal epidemiology in sub-Saharan African countries are scarce. This exploratory study aimed to characterize the fungal flora at the Onco-Haematology ward of the National Teaching Hospital of Point G in Bamako, Mali. A cross-sectional survey was conducted in the dry and in the rainy seasons. Nasal swab and sputum samples were collected from the hospitalized patients while airborne fungal spores were collected using electrostatic dust-fall collectors. Fungi were identified by their morphological characteristics and MALDI-TOF mass spectrometry. Candida albicans was the most frequent yeast species colonizing patients; Aspergillus species were isolated in 86 % of the patients and were the main airborne environmental contaminants. Overall, airborne fungal contamination rates increased from 33.8 % in the dry to 66.2 % in the rainy season (p < 0.001). The most frequent Aspergillus species were Aspergillus niger (36.6 %) and Aspergillus flavus (32.92 %). In contrast, Aspergillus fumigatus (5.43 %) was relatively rare. This high level of fungal exposure raises concern regarding the management of at-risk patients in this Onco-Haematology ward and stresses the need for strengthening the mycological diagnostic capacities to accompany the implementation of adapted fungal infection prevention and management policies.
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Affiliation(s)
- Safiatou Niaré-Doumbo
- Département d'Epidémiologie des Affections Parasitaires/Malaria Research and Training Centre, Faculté de Médecine et d'Odontostomatologie, USTTB, BP 1805, Bamako, Mali
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57
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A 10-year survey of fungal aerocontamination in hospital corridors: a reliable sentinel to predict fungal exposure risk? J Hosp Infect 2014; 87:34-40. [DOI: 10.1016/j.jhin.2014.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 02/19/2014] [Indexed: 11/20/2022]
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58
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Menegueti MG, Ferreira LR, Silva MFI, Silva ASD, Bellissimo-Rodrigues F. Assessment of microbiological air quality in hemato-oncology units and its relationship with the occurrence of invasive fungal infections: an integrative review. Rev Soc Bras Med Trop 2014; 46:391-6. [PMID: 23904085 DOI: 10.1590/0037-8682-0022-2013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 05/25/2013] [Indexed: 11/22/2022] Open
Abstract
Worldwide aging of the human population has promoted an increase in the incidence of neoplasia, including hematological cancers, which render patients particularly vulnerable to invasive fungal infections. For this reason, air filtration in hematooncology units has been recommended. However, scarce literature has assessed the impact of microbiological air quality on the occurrence of fungal infections in this population. We performed an integrative review of studies in the MEDLINE database that were published between January 1980 and October 2012, using the following combinations of keywords: air × quality × HEPA, air × quality × hematology, and airborne fungal infections. The search yielded only 13 articles, suggesting that high-efficiency filtering of the ambient air in hemato-oncology units can prevent the incidence of invasive fungal infections. However, no randomized clinical trial was found to confirm this suggestion. Currently, there is no consensus about the maximum allowable count of fungi in the air, which complicates filtration monitoring, including filter maintenance and replacement, and needs to be addressed in future studies.
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Affiliation(s)
- Mayra Gonçalves Menegueti
- Comissão de Controle de Infecção Hospitalar, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP
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59
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Cafarchia C, Camarda A, Iatta R, Danesi P, Favuzzi V, Di Paola G, Pugliese N, Caroli A, Montagna MT, Otranto D. Environmental contamination by Aspergillus spp. in laying hen farms and associated health risks for farm workers. J Med Microbiol 2014; 63:464-470. [PMID: 24430250 DOI: 10.1099/jmm.0.065946-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Data on the occurrence and epidemiology of Aspergillus spp. in laying hens farms are scant. With the aims of determining levels of airborne contamination in laying hen farms and evaluating the potential risk of infection for workers and animals, 57 air samples from 19 sheds (Group I), 69 from faeces (Group II), 19 from poultry feedstuffs (Group III) and 60 from three anatomical sites (i.e. nostrils, pharynx, ears) of 20 farm workers (Group IV) were cultured. The Aspergillus spp. prevalence in samples ranged from 31.6% (Group III) to 55.5% (Group IV), whereas the highest conidia concentration was retrieved in Group II (1.2 × 10(4) c.f.u. g(-1)) and in Group III (1.9 × 10(3) c.f.u. g(-1)). The mean concentration of airborne Aspergillus spp. conidia was 70 c.f.u. m(-3) with Aspergillus fumigatus (27.3%) being the most frequently detected species, followed by Aspergillus flavus (6.3%). These Aspergillus spp. were also isolated from human nostrils (40%) and ears (35%) (P<0.05) (Group IV). No clinical aspergillosis was diagnosed in hens. The results demonstrate a relationship between the environmental contamination in hen farms and presence of Aspergillus spp. on animals and humans. Even if the concentration of airborne Aspergillus spp. conidia (i.e. 70 c.f.u. m(-3)) herein detected does not trigger clinical disease in hens, it causes human colonization. Correct management of hen farms is necessary to control environmental contamination by Aspergillus spp., and could lead to a significant reduction of animal and human colonization.
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Affiliation(s)
- Claudia Cafarchia
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Str. prov. le per Casamassima Km 3, 70010 Valenzano, Bari, Italy
| | - Antonio Camarda
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Str. prov. le per Casamassima Km 3, 70010 Valenzano, Bari, Italy
| | - Roberta Iatta
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Str. prov. le per Casamassima Km 3, 70010 Valenzano, Bari, Italy
| | - Patrizia Danesi
- Istituto Zooprofilattico Sperimentale delle Venezie, Viale dell'Università, 1035020 Legnaro (PD), Italy
| | - Vincenza Favuzzi
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Str. prov. le per Casamassima Km 3, 70010 Valenzano, Bari, Italy
| | - Giancarlo Di Paola
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Str. prov. le per Casamassima Km 3, 70010 Valenzano, Bari, Italy
| | - Nicola Pugliese
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Str. prov. le per Casamassima Km 3, 70010 Valenzano, Bari, Italy
| | - Anna Caroli
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Str. prov. le per Casamassima Km 3, 70010 Valenzano, Bari, Italy
| | - Maria Teresa Montagna
- Dipartimento di Scienze Biomediche ed Oncologia Umana, Università degli Studi di Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Domenico Otranto
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari, Str. prov. le per Casamassima Km 3, 70010 Valenzano, Bari, Italy
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Abstract
Invasive fungal infections (IFI) have become a leading cause of morbidity and mortality in cancer patients. Infections with these organisms are often difficult to diagnose and treat. Appropriate and timely diagnosis requires a high index of suspicion and invasive procedures, including biopsy, to confirm the diagnosis. Treatment may be difficult, secondary to variable susceptibility and difficulty with exact and specific characterization of the fungal pathogen. The pathogens that are seen range from yeasts to invasive molds. Fortunately newer, noninvasive diagnostic techniques are available to aid in the diagnosis and treatments have become better tolerated and more efficacious.
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Affiliation(s)
- Michael Angarone
- Division of Infectious Disease, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Suite 900, Chicago, IL, 60611, USA,
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61
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Cavallo M, Andreoni S, Martinotti MG, Rinaldi M, Fracchia L. Monitoring environmental Aspergillus spp. contamination and meteorological factors in a haematological unit. Mycopathologia 2013; 176:387-94. [PMID: 24158616 DOI: 10.1007/s11046-013-9712-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 10/09/2013] [Indexed: 12/12/2022]
Abstract
The opportunistic pathogens belonging to the Aspergillus genus are present in almost all seasons of the year, and their concentration is related to meteorological conditions. The high density of Aspergillus spp. conidia in a haematological hospital ward may be a significant risk factor for developing invasive fungal diseases in immunocompromised patients. Aim of the present study was to evaluate the variability of airborne Aspergillus spp. conidia contamination in a Haematological Unit (HU) within a period of 16 months in relation with some meteorological parameters. An environmental Aspergillus surveillance was conducted in the HU in four rooms and their bathrooms, in the corridor and in three external sites using an agar impact sampler. During each sampling, temperature and relative humidity at each site were recorded and current wind speed and rainfall events were taken from the official weather service. Aspergillus spp. conidia concentration differed significantly across the sampling sites. Internal Aspergillus spp. loads were significantly dependent on temperature, internal relative humidity and rain. External conidia concentrations were significantly influenced by outdoor temperature and relative humidity. A suitable indicator was introduced to evaluate the seasonal distribution of Aspergillus spp. conidia in the sampling sites, and a significant dependence on this indicator was observed inside the HU. Seventeen different fungal species belonging to the Aspergillus genus were detected during the sampling period. Aspergillus fumigatus was the most frequently isolated species and its distribution depended significantly on the seasonal indicator both inside and outside the hospital ward.
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Affiliation(s)
- M Cavallo
- Dipartimento di Scienze del Farmaco, Università del Piemonte Orientale "A. Avogadro", Largo Donegani 2, 28100, Novara, Italy
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Leleu C, Menotti J, Meneceur P, Choukri F, Sulahian A, Garin YJF, Denis JB, Derouin F. Bayesian development of a dose-response model for Aspergillus fumigatus and invasive aspergillosis. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2013; 33:1441-1453. [PMID: 23311627 DOI: 10.1111/risa.12007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Invasive aspergillosis (IA) is a major cause of mortality in immunocompromized hosts, most often consecutive to the inhalation of spores of Aspergillus. However, the relationship between Aspergillus concentration in the air and probability of IA is not quantitatively known. In this study, this relationship was examined in a murine model of IA. Immunosuppressed Balb/c mice were exposed for 60 minutes at day 0 to an aerosol of A. fumigatus spores (Af293 strain). At day 10, IA was assessed in mice by quantitative culture of the lungs and galactomannan dosage. Fifteen separate nebulizations with varying spore concentrations were performed. Rates of IA ranged from 0% to 100% according to spore concentrations. The dose-response relationship between probability of infection and spore exposure was approximated using the exponential model and the more flexible beta-Poisson model. Prior distributions of the parameters of the models were proposed then updated with data in a Bayesian framework. Both models yielded close median dose-responses of the posterior distributions for the main parameter of the model, but with different dispersions, either when the exposure dose was the concentration in the nebulized suspension or was the estimated quantity of spores inhaled by a mouse during the experiment. The median quantity of inhaled spores that infected 50% of mice was estimated at 1.8 × 10(4) and 3.2 × 10(4) viable spores in the exponential and beta-Poisson models, respectively. This study provides dose-response parameters for quantitative assessment of the relationship between airborne exposure to the reference A. fumigatus strain and probability of IA in immunocompromized hosts.
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Affiliation(s)
- Christopher Leleu
- Université Paris Diderot, Sorbonne Paris Cité, EA 3520, Paris, France.
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63
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Aboul-Nasr MB, Zohri ANA, Amer EM. Enzymatic and toxigenic ability of opportunistic fungi contaminating intensive care units and operation rooms at Assiut University Hospitals, Egypt. SPRINGERPLUS 2013; 2:347. [PMID: 23961411 PMCID: PMC3733072 DOI: 10.1186/2193-1801-2-347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 07/26/2013] [Indexed: 11/10/2022]
Abstract
Total of 110 isolates belonging to 8 fungal species collected from intensive care units (ICUs) and operation rooms (ORs) at Assiut University hospitals were examined for their ability to produce some extracellular enzymes and mycotoxins which are considered as important factors involved in for fungal pathogenicity. The results revealed that 73, 92 and 78 out of the 110 tested isolates produced protease, lipase and urease respectively; meanwhile, 77 of the tested isolates exhibited some hemolytic activities. Chromatographic analysis (TLC) of the crude extract of the fungal isolates tested revealed that 79 isolates of them had the ability to produce at least one of these mycotoxic compounds (aflatoxins B1, B2, G1, gliotoxin, fumigillin, T-2, zearalenone, roridin A & E, verrucarin A & J, trichoveroids, satratoxin H & E). These results demonstrate that the opportunistic fungal species isolated from (ICUs) and (ORs) and tested exhibited some enzymatic and mycotoxic ability which are the most effective virulence factors contributing to fungal pathogenicity indicating that the management of infection control unit at Assiut University hospitals must be aware of not only bacterial but also fungal contamination.
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Performance of serum biomarkers for the early detection of invasive aspergillosis in febrile, neutropenic patients: a multi-state model. PLoS One 2013; 8:e65776. [PMID: 23799048 PMCID: PMC3683047 DOI: 10.1371/journal.pone.0065776] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 04/26/2013] [Indexed: 12/31/2022] Open
Abstract
Background The performance of serum biomarkers for the early detection of invasive aspergillosis expectedly depends on the timing of test results relative to the empirical administration of antifungal therapy during neutropenia, although a dynamic evaluation framework is lacking. Methods We developed a multi-state model describing simultaneously the likelihood of empirical antifungal therapy and the risk of invasive aspergillosis during neutropenia. We evaluated whether the first positive test result with a biomarker is an independent predictor of invasive aspergillosis when both diagnostic information used to treat and risk factors of developing invasive aspergillosis are taken into account over time. We applied the multi-state model to a homogeneous cohort of 185 high-risk patients with acute myeloid leukemia. Patients were prospectively screened for galactomannan antigenemia twice a week for immediate treatment decision; 2,214 serum samples were collected on the same days and blindly assessed for (1->3)- β-D-glucan antigenemia and a quantitative PCR assay targeting a mitochondrial locus. Results The usual evaluation framework of biomarker performance was unable to distinguish clinical benefits of β-glucan or PCR assays. The multi-state model evidenced that the risk of invasive aspergillosis is a complex time function of neutropenia duration and risk management. The quantitative PCR assay accelerated the early detection of invasive aspergillosis (P = .010), independently of other diagnostic information used to treat, while β-glucan assay did not (P = .53). Conclusions The performance of serum biomarkers for the early detection of invasive aspergillosis is better apprehended by the evaluation of time-varying predictors in a multi-state model. Our results provide strong rationale for prospective studies testing a preemptive antifungal therapy, guided by clinical, radiological, and bi-weekly blood screening with galactomannan antigenemia and a standardized quantitative PCR assay.
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65
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Méheust D, Le Cann P, Reboux G, Millon L, Gangneux JP. Indoor fungal contamination: health risks and measurement methods in hospitals, homes and workplaces. Crit Rev Microbiol 2013; 40:248-60. [PMID: 23586944 DOI: 10.3109/1040841x.2013.777687] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Indoor fungal contamination has been associated with a wide range of adverse health effects, including infectious diseases, toxic effects and allergies. The diversity of fungi contributes to the complex role that they play in indoor environments and human diseases. Molds have a major impact on public health, and can cause different consequences in hospitals, homes and workplaces. This review presents the methods used to assess fungal contamination in these various environments, and discusses advantages and disadvantages for each method in consideration with different health risks. Air, dust and surface sampling strategies are compared, as well as the limits of various methods are used to detect and quantify fungal particles and fungal compounds. In addition to conventional microscopic and culture approaches, more recent chemical, immunoassay and polymerase chain reaction (PCR)-based methods are described. This article also identifies common needs for future multidisciplinary research and development projects in this field, with specific interests on viable fungi and fungal fragment detections. The determination of fungal load and the detection of species in environmental samples greatly depend on the strategy of sampling and analysis. Quantitative PCR was found useful to identify associations between specific fungi and common diseases. The next-generation sequencing methods may afford new perspectives in this area.
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66
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BRUN CP, MIRON D, SILLA LMR, PASQUALOTTO AC. Fungal spore concentrations in two haematopoietic stem cell transplantation (HSCT) units containing distinct air control systems. Epidemiol Infect 2013; 141:875-9. [PMID: 22691688 PMCID: PMC9151894 DOI: 10.1017/s0950268812001124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/10/2012] [Accepted: 05/10/2012] [Indexed: 11/06/2022] Open
Abstract
Invasive fungal diseases have emerged as important causes of morbidity and mortality in haematological patients. In this study air samples were collected in two haematopoietic stem cell transplantation (HSCT) units, in which distinct air-control systems were in place. In hospital 1 no high-efficiency particulate air (HEPA) filter was available whereas in hospital 2 HSCT rooms were equipped with HEPA filters, with positive air pressure in relation to the corridor. A total of 117 samples from rooms, toilets and corridors were obtained during December 2009 to January 2011, using a six-stage Andersen sampler. In both hospitals, the concentration of potentially pathogenic fungi in the air was reduced in patients' rooms compared to corridors (P < 0·0001). Despite the presence of a HEPA filter in hospital 2, rooms in both hospitals showed similar concentrations of potentially pathogenic fungi (P = 0·714). These findings may be explained by the implementation of additional protective measures in hospital 1, emphasizing the importance of such measures in protected environments.
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Affiliation(s)
- C. P. BRUN
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Santa Casa Complexo Hospitalar, Porto Alegre, Brazil
| | - D. MIRON
- Universidade de Caxias do Sul, Caxias do Sul, Brazil
| | - L. M. R. SILLA
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - A. C. PASQUALOTTO
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Santa Casa Complexo Hospitalar, Porto Alegre, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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67
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Méheust D, Le Cann P, Gangneux JP. Rapid quantification of viable fungi in hospital environments: analysis of air and surface samples using solid-phase cytometry. J Hosp Infect 2013; 83:122-6. [DOI: 10.1016/j.jhin.2012.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 10/14/2012] [Indexed: 11/24/2022]
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Invasive aspergillosis: drug-dispensing systems as a source of filamentous fungal contamination in high-risk units? J Hosp Infect 2012; 82:293-6. [PMID: 23102819 DOI: 10.1016/j.jhin.2012.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 08/24/2012] [Indexed: 11/23/2022]
Abstract
High-risk units with air-control measures at Grenoble University Hospital are equipped with automated dispensing systems that are filled daily using drug trolleys routed from the pharmacy to the ward. The aim of this study was to evaluate the level of filamentous fungi (FF) contamination present in trolleys under usual conditions and after cleaning with Aniosurf(®) (fungicidal disinfectant). FF were detected in all samples, and 83.3% of samples were contaminated with Aspergillus fumigatus. Cleaning trolleys with Aniosurf(®) decreased the level of FF significantly, but contamination re-appeared within 24 h due to storage in a non-controlled environment.
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69
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Monitoring the occurrence of indoor fungi in a hospital. Rev Iberoam Micol 2012; 29:227-34. [DOI: 10.1016/j.riam.2012.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 04/11/2012] [Accepted: 04/17/2012] [Indexed: 11/24/2022] Open
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70
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Fernandez IJ, Stanzani M, Tolomelli G, Pasquini E, Vianelli N, Baccarani M, Sciarretta V. Sinonasal risk factors for the development of invasive fungal sinusitis in hematological patients: Are they important? ALLERGY & RHINOLOGY 2012; 2:6-11. [PMID: 22852108 PMCID: PMC3390131 DOI: 10.2500/ar.2011.2.0009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Invasive fungal sinusitis (IFS) is a highly aggressive infection that can affect hematologic patients. The classically described general risk factors, however, do not fully explain the development of IFS in a small percentage of cases. This study examined the impact of anatomic sinonasal factors and environmental factors on the development of IFS in high-risk patients. Medical records and computed tomography (CT) scans of patients admitted to our institution who were at high risk of developing IFS were retrospectively reviewed. Twenty-seven patients of 797 fulfilled the inclusion criteria. Patients affected by IFS were compared with patients not affected to identify possible sinonasal and environmental risk factors of IFS. Seven patients were excluded because of the lack of adequate radiological images. Six of the 20 eligible patients were assigned to the study group of patients affected by IFS and the remaining 14 patients were assigned to the control group. All but one case developed the infection during the summer with a significantly higher mean environmental temperature (p = 0.002). Anatomic nasal alterations were found in all patients affected by IFS and were significantly more frequent than in the control group (p = 0.014). It would be advisable to have patients with hematologic risk factors of IFS, especially during the summer period, undergo endoscopic nasal assessment. Furthermore, a CT finding of anatomic nasal alterations, such as anterior nasal septum deviation causing nasal obstruction, should increase the suspicion of IFS in case of the occurrence of nasal symptoms.
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71
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Napoli C, Marcotrigiano V, Montagna MT. Air sampling procedures to evaluate microbial contamination: a comparison between active and passive methods in operating theatres. BMC Public Health 2012; 12:594. [PMID: 22853006 PMCID: PMC3444341 DOI: 10.1186/1471-2458-12-594] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 07/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since air can play a central role as a reservoir for microorganisms, in controlled environments such as operating theatres regular microbial monitoring is useful to measure air quality and identify critical situations. The aim of this study is to assess microbial contamination levels in operating theatres using both an active and a passive sampling method and then to assess if there is a correlation between the results of the two different sampling methods. METHODS The study was performed in 32 turbulent air flow operating theatres of a University Hospital in Southern Italy. Active sampling was carried out using the Surface Air System and passive sampling with settle plates, in accordance with ISO 14698. The Total Viable Count (TVC) was evaluated at rest (in the morning before the beginning of surgical activity) and in operational (during surgery). RESULTS The mean TVC at rest was 12.4 CFU/m3 and 722.5 CFU/m2/h for active and passive samplings respectively. The mean in operational TVC was 93.8 CFU/m3 (SD = 52.69; range = 22-256) and 10496.5 CFU/m2/h (SD = 7460.5; range = 1415.5-25479.7) for active and passive samplings respectively. Statistical analysis confirmed that the two methods correlate in a comparable way with the quality of air. CONCLUSION It is possible to conclude that both methods can be used for general monitoring of air contamination, such as routine surveillance programs. However, the choice must be made between one or the other to obtain specific information.
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Affiliation(s)
- Christian Napoli
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Piazza G, Cesare, 11, 70124, Bari, Italy.
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Salvatori G, Campo S. Current understanding of PTX3 protective activity onAspergillus fumigatusinfection. Med Mycol 2012; 50:225-33. [DOI: 10.3109/13693786.2011.648215] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Drahota A, Ward D, Mackenzie H, Stores R, Higgins B, Gal D, Dean TP. Sensory environment on health-related outcomes of hospital patients. Cochrane Database Syst Rev 2012; 2012:CD005315. [PMID: 22419308 PMCID: PMC6464891 DOI: 10.1002/14651858.cd005315.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hospital environments have recently received renewed interest, with considerable investments into building and renovating healthcare estates. Understanding the effectiveness of environmental interventions is important for resource utilisation and providing quality care. OBJECTIVES To assess the effect of hospital environments on adult patient health-related outcomes. SEARCH METHODS We searched: the Cochrane Central Register of Controlled Trials (last searched January 2006); MEDLINE (1902 to December 2006); EMBASE (January 1980 to February 2006); 14 other databases covering health, psychology, and the built environment; reference lists; and organisation websites. This review is currently being updated (MEDLINE last search October 2010), see Studies awaiting classification. SELECTION CRITERIA Randomised and non-randomised controlled trials, controlled before-and-after studies, and interrupted times series of environmental interventions in adult hospital patients reporting health-related outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently undertook data extraction and 'Risk of bias' assessment. We contacted authors to obtain missing information. For continuous variables, we calculated a mean difference (MD) or standardized mean difference (SMD), and 95% confidence intervals (CI) for each study. For dichotomous variables, we calculated a risk ratio (RR) with 95% confidence intervals (95% CI). When appropriate, we used a random-effects model of meta-analysis. Heterogeneity was explored qualitatively and quantitatively based on risk of bias, case mix, hospital visit characteristics, and country of study. MAIN RESULTS Overall, 102 studies have been included in this review. Interventions explored were: 'positive distracters', to include aromas (two studies), audiovisual distractions (five studies), decoration (one study), and music (85 studies); interventions to reduce environmental stressors through physical changes, to include air quality (three studies), bedroom type (one study), flooring (two studies), furniture and furnishings (one study), lighting (one study), and temperature (one study); and multifaceted interventions (two studies). We did not find any studies meeting the inclusion criteria to evaluate: art, access to nature for example, through hospital gardens, atriums, flowers, and plants, ceilings, interventions to reduce hospital noise, patient controls, technologies, way-finding aids, or the provision of windows. Overall, it appears that music may improve patient-reported outcomes such as anxiety; however, the benefit for physiological outcomes, and medication consumption has less support. There are few studies to support or refute the implementation of physical changes, and except for air quality, the included studies demonstrated that physical changes to the hospital environment at least did no harm. AUTHORS' CONCLUSIONS Music may improve patient-reported outcomes in certain circumstances, so support for this relatively inexpensive intervention may be justified. For some environmental interventions, well designed research studies have yet to take place.
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Affiliation(s)
- Amy Drahota
- UK Cochrane Centre, National Institute for Health Research, Oxford, UK.
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74
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[Quantitative assessment of fungal risk in the case of construction works in healthcare establishments: Proposed indicators for the determination of the impact of management precautions on the risk of fungal infection]. J Mycol Med 2012. [PMID: 23177816 DOI: 10.1016/j.mycmed.2012.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Construction works in healthcare establishments produce airborne fungal spores and considerably increase the risk of exposure of immunosuppressed patients. It is necessary to reinforce protective measures, or even to implement specific precautions, during this critical phase. The aim of these precautions is to protect both those areas, which are susceptible to dust, and patients at risk of a fungal infection particularly invasive aspergillosis. When construction works are planned in healthcare establishments, the first step consists in the characterisation of the environmental fungal risk and the second one in proposing risk management methods. It is then essential to establish impact indicators in order to evaluate the risk management precautions applied. The working group promoted by the French societies of medical mycology and hospital hygiene (SFMM & SF2H) details here both environmental and epidemiological impact indicators that can be used.
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Invasive fungal infections in patients with hematologic malignancies (aurora project): lights and shadows during 18-months surveillance. Int J Mol Sci 2012; 13:774-787. [PMID: 22312285 PMCID: PMC3269719 DOI: 10.3390/ijms13010774] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 12/22/2011] [Accepted: 01/04/2012] [Indexed: 12/21/2022] Open
Abstract
The aim of this multicenter prospective study was to evaluate the incidence of invasive fungal infections (IFIs) in adult and pediatric patients with hematologic malignancies, involving nine nosocomial facilities in Southern Italy over a period of 18 months. Furthermore, results of an environmental microbial surveillance routinely carried out in some of the enrolled hospitals are reported. A total of 589 onco-hematological patients were enrolled and 27 IFIs were documented. The main infections were caused by yeasts, more than filamentous fungi (overall incidence of 2.7% and 1.9%, respectively). The yeasts were mainly represented by Candida spp. (87.5%), all isolated by blood cultures; C. parapsilosis was the most common species. Among mould infections, the most frequent site was the lung, with regard to aspergillosis (81.8%). In six of the 10 patients with suspected aspergillosis, the diagnosis was made by the detection of galactomannan and (1,3)-β-d-glucan antigens. The microbiological surveillance carried out on 156 air, 312 water and 312 surface samples revealed low environmental contamination: Alternaria alternata was the only fungus isolated from two surface samples. Our data, especially the low occurrence of filamentous fungi, suggest a particular local epidemiology. Further studies are needed to confirm this microbiological trend in onco-hematological patients in Southern Italy, the results of which might be helpful to improve the management of these patients.
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Pelaez T, Munoz P, Guinea J, Valerio M, Giannella M, Klaassen CHW, Bouza E. Outbreak of Invasive Aspergillosis After Major Heart Surgery Caused by Spores in the Air of the Intensive Care Unit. Clin Infect Dis 2012; 54:e24-31. [DOI: 10.1093/cid/cir771] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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77
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Sautour M, Fournel I, Dalle F, Calinon C, L'Ollivier C, Goyer M, Cachia C, Aho S, Sixt N, Vagner O, Cuisenier B, Bonnin A. Dynamics of fungal colonization in a new medical mycology laboratory. J Mycol Med 2011. [PMID: 23177809 DOI: 10.1016/j.mycmed.2011.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE OF THE STUDY Study of the spatio-temporal fungal colonization in a new medical mycology laboratory. METHODS A 17-month survey of airborne fungal contamination was conducted in a new medical mycology laboratory at a tertiary care university hospital. This survey was implemented at three different periods: before the new premises were occupied (period A), during the move into the new laboratory (period B) and after resumption of the mycological activities in these new premises (period C). RESULTS During period A, the airborne fungal load ranged from 2.3 to 6 cfu/m(3). The most frequently recovered airborne fungi were Penicillium spp. (75 to 100%). During period B, a dramatic increase in Penicillium chrysogenum conidia was observed in the air of the new laboratory (40 to 160 cfu/m(3)). During period C, the fungal load ranged from 4.5 to 8.4 cfu/m(3). Penicillium was the most common genus identified in rooms of the laboratory where no filamentous fungi were handled, while Aspergillus was clearly the predominant genus (78%) in the room dedicated to the culture of filamentous fungi. CONCLUSIONS We suggest that the specific fungal ecology in air of the room dedicated to the culture of filamentous fungi is due to the handling of a large number of medical strains of A. fumigatus.
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Affiliation(s)
- M Sautour
- Laboratoire de parasitologie-mycologie, plateau technique de biologie du CHU, 2, rue Angélique-Ducoudray, BP 37013, 21070 Dijon cedex, France.
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Berger J, Willinger B, Diab-Elschahawi M, Blacky A, Kalhs P, Koller W, Assadian O, Aichberger KJ. Effectiveness of preventive measures for hemato-oncologic patients undergoing stem cell transplantation during a period of hospital construction. Am J Infect Control 2011; 39:746-51. [PMID: 21704432 DOI: 10.1016/j.ajic.2011.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Revised: 01/25/2011] [Accepted: 01/25/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Aspergillus spp are ubiquitous spore-forming fungi. Construction work, renovation, demolition, or excavation activities within a hospital or in surrounding areas increase the risk for aspergillus infection in susceptible patients and are the main cause of nosocomial aspergillus outbreaks. METHODS We investigated the efficacy of infection control measures on the frequency of fungal infection among hemato-oncologic patients undergoing stem cell transplantation during excavation and construction work of an adjacent hospital building. Clinical isolates from these patients obtained before and during the excavation and construction period were analyzed. Preventive measures consisted in the implementation of a multibarrier concept to protect these patients from fungal infection. RESULTS There was no record of any clinical isolate of Aspergillus spp in the observation period before the beginning of the groundwork. However, 3 clinically significant isolates of Aspergillus spp were detected in respiratory tract specimen of 2 patients after the beginning of excavation and demolition work, which were found to be community acquired. CONCLUSION Although our data cannot demonstrate the efficacy of infection control measures during construction work, it can be concluded that excavation work close to immunocompromised patients is safe if a bundle of preventive measures is implemented before groundwork.
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Affiliation(s)
- Jutta Berger
- Division of Hospital Hygiene, Clinical Institute for Hygiene and Medical Microbiology, Medical University Vienna, Austria
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Brenier-Pinchart MP, Lebeau B, Borel JL, Quesada JL, Mallaret M, Garban F, Brion JP, Molina L, Bosson JL, Thiebaut-Bertrand A, Grillot R, Pelloux H. Community-acquired invasive aspergillosis and outdoor filamentous fungal spore load: a relationship? Clin Microbiol Infect 2011; 17:1387-90. [DOI: 10.1111/j.1469-0691.2011.03523.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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80
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Rüping MJGT, Vehreschild JJ, Groll A, Lass-Flörl C, Ostermann H, Ruhnke M, Cornely OA. Current issues in the clinical management of invasive aspergillosis--the AGIHO, DMykG, ÖGMM and PEG web-based survey and expert consensus conference 2009. Mycoses 2011; 54:e557-68. [PMID: 21518025 DOI: 10.1111/j.1439-0507.2010.01989.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objectives of this study were to identify unsolved issues in the management of invasive aspergillosis, identify controversies and achieve consensus. The German Speaking Mycological Society (Deutschsprachige Mykologische Gesellschaft, DMykG) invited other German infectious diseases (ID) and mycological societies to submit unsolved issues concerning the diagnosis and treatment of invasive aspergillosis. Based on these contributions, a digital web-based questionnaire of 12 questions on Aspergillus spp. was designed to be completed by experts of the participating societies. Controversial results were identified by a mathematical model and were discussed at a consensus conference during the 43rd Annual Meeting of the DMykG in Cologne, Germany. Forty-two individuals completed the questionnaire. Analysis showed a strong consensus on effective preventive measures, choice of antifungal agents for pre-emptive, empiric and targeted treatment, as well as the evaluation of early chest CT control scans as a measure of treatment response assessment. Opinions on the indication for a pulmonary biopsy of a halo sign in high-risk neutropenic patients and on the role of Aspergillus spp. PCR as well as galactomannan from serum in the assessment of treatment duration diverged in spite of discussion such that a consensus could not be reached. Using a recently published two-step approach - web-based survey plus classical panel discussion - expert consensus was achieved on 10 of 12 questions concerning the diagnosis and treatment of invasive aspergillosis.
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Affiliation(s)
- M J G T Rüping
- 1st Department of Internal Medicine, University of Cologne, Cologne, Germany
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81
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Ruiz-Camps I, Aguado J, Almirante B, Bouza E, Ferrer-Barbera C, Len O, Lopez-Cerero L, Rodríguez-Tudela J, Ruiz M, Solé A, Vallejo C, Vazquez L, Zaragoza R, Cuenca-Estrella M. Guidelines for the prevention of invasive mould diseases caused by filamentous fungi by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). Clin Microbiol Infect 2011; 17 Suppl 2:1-24. [DOI: 10.1111/j.1469-0691.2011.03477.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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82
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Vescia N, Brenier-Pinchart MP, Osborn JF, Cerquetani F, Cavarischia R, Grillot R, D’Alessandro D. Field validation of a dusting cloth for mycological surveillance of surfaces. Am J Infect Control 2011; 39:156-8. [PMID: 20817315 DOI: 10.1016/j.ajic.2010.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 05/03/2010] [Accepted: 05/03/2010] [Indexed: 10/19/2022]
Abstract
Efficient monitoring of surfaces for spores of filamentous fungi is essential for detecting minor contamination even when air samples test negative for fungi. This study evaluates and compares a pad prepared using a dusting cloth with Rodac contact plates and humidified swabs for detecting mycological contamination, and concludes that the new method is superior and cheaper.
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83
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Takuma T, Okada K, Yamagata A, Shimono N, Niki Y. Mold colonization of fiberglass insulation of the air distribution system: effects on patients with hematological malignancies. Med Mycol 2011; 49:150-6. [DOI: 10.3109/13693786.2010.510149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Discrimination between nosocomial and community infections is important for investigation and prevention. Nosocomial and hospital-acquired infections require appropriate hospital control measures to avert additional cases. Nosocomial infections (NI) occur during hospitalization or are caused by microorganisms acquired during hospital stay. Such infections should not be evident when patients are admitted to the hospital. Furthermore, the definition of NI is based on epidemiological criteria, such as the time lapse between admission and onset, or microbiological criteria. This definition might be difficult to apply to invasive aspergillosis (IA) which often afflicts patients with severe immunosuppression or transplantation. Identification of the source may be difficult which could arise outside or inside the hospital. Another significant issue is the lack of valid and reproducible data on the incubation period. The incubation duration of IA is influenced by different individual or environmental determinants, including the severity of immunosuppression and air quality. The criteria of causality are also a means of discussing the contribution of hospital vs. community determinants of IA. The definition of nosocomial IA remains difficult. A better understanding of early events related to IA onset will help to prevent this disease for which the prognosis remains negative.
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Affiliation(s)
- Marie-Christine Nicolle
- Service d'Hygiène Hospitalière, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 place d'Arsonval, Lyon, France
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Menotti J, Porcher R, Ribaud P, Lacroix C, Jolivet V, Hamane S, Derouin F. Monitoring of nosocomial invasive aspergillosis and early evidence of an outbreak using cumulative sum tests (CUSUM). Clin Microbiol Infect 2010. [DOI: 10.1111/j.1469-0691.2010.03150.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hadrich I, Makni F, Sellami H, Cheikhrouhou F, Sellami A, Bouaziz H, Hdiji S, Elloumi M, Ayadi A. Invasive aspergillosis: epidemiology and environmental study in haematology patients (Sfax, Tunisia). Mycoses 2010; 53:443-7. [DOI: 10.1111/j.1439-0507.2009.01710.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chabrol A, Cuzin L, Huguet F, Alvarez M, Verdeil X, Linas MD, Cassaing S, Giron J, Tetu L, Attal M, Récher C. Prophylaxis of invasive aspergillosis with voriconazole or caspofungin during building work in patients with acute leukemia. Haematologica 2010; 95:996-1003. [PMID: 20007135 PMCID: PMC2878800 DOI: 10.3324/haematol.2009.012633] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 11/03/2009] [Accepted: 11/19/2009] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Invasive aspergillosis is a common life-threatening infection in patients with acute leukemia. The presence of building work near to hospital wards in which these patients are cared for is an important risk factor for the development of invasive aspergillosis. This study assessed the impact of voriconazole or caspofungin prophylaxis in patients undergoing induction chemotherapy for acute leukemia in a hematology unit exposed to building work. DESIGN AND METHODS This retrospective cohort study was carried out between June 2003 and January 2006 during which building work exposed patients to a persistently increased risk of invasive aspergillosis. This study compared the cumulative incidence of invasive aspergillosis in patients who did or did not receive primary antifungal prophylaxis. The diagnosis of invasive aspergillosis was based on the European Organization for Research and Treatment of Cancer/Mycosis Study Group criteria. RESULTS Two-hundred and fifty-seven patients (213 with acute myeloid leukemia, 44 with acute lymphocytic leukemia) were included. The mean age of the patients was 54 years and the mean duration of their neutropenia was 21 days. Eighty-eight received antifungal prophylaxis, most with voriconazole (n=74). The characteristics of the patients who did or did not receive prophylaxis were similar except that pulmonary antecedents (chronic bronchopulmonary disorders or active tobacco use) were more frequent in the prophylaxis group. Invasive aspergillosis was diagnosed in 21 patients (12%) in the non-prophylaxis group and four (4.5%) in the prophylaxis group (P=0.04). Pulmonary antecedents, neutropenia at diagnosis and acute myeloid leukemia with high-risk cytogenetics were positively correlated with invasive aspergillosis, whereas primary prophylaxis was negatively correlated. Survival was similar in both groups. No case of zygomycosis was observed. The 3-month mortality rate was 28% in patients with invasive aspergillosis. CONCLUSIONS This study suggests that antifungal prophylaxis with voriconazole could be useful in acute leukemia patients undergoing first remission-induction chemotherapy in settings in which there is a high-risk of invasive aspergillosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Laurent Tetu
- Department of Pulmonary Diseases, Toulouse University Hospital, Toulouse, France
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Abdul Salam ZH, Karlin RB, Ling ML, Yang KS. The impact of portable high-efficiency particulate air filters on the incidence of invasive aspergillosis in a large acute tertiary-care hospital. Am J Infect Control 2010; 38:e1-7. [PMID: 20129702 DOI: 10.1016/j.ajic.2009.09.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 09/20/2009] [Accepted: 09/21/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Worldwide, the frequency of invasive fungal infections has been increasing, with a corresponding increase in the numbers of high-risk patients. Exposure reduction through the use of high-efficiency particulate air (HEPA) filters has been the preferred primary preventive strategy for these high-risk patients. Although the efficiency and benefits of fixed HEPA filters is well proven, the benefits of portable HEPA filters are still inconclusive. METHODS This was a retrospective study to assess the impact of 48 portable HEPA filter units deployed in selected wards in Singapore General Hospital, an acute tertiary-care hospital in Singapore. Data were extracted between December 2005 and June 2008 on the diagnoses at discharge and microbiological and histological laboratory findings. All patients with possible, probable, or proven invasive aspergillosis (IA) were included. RESULTS In wards with portable HEPA filters, the incidence rate of IA of 34.61/100,000 patient-days in the pre-installation period was reduced to 17.51/100,000 patient-days in the post-installation period (P = .01), for an incidence rate ratio of 1.98 (95% confidence interval [CI], 1.10-2.97). In wards with no HEPA filters, there was no significant change in the incidence rate during the study period. Portable HEPA filters were associated with an adjusted odds ratio of 0.49 (95% CI, 0.28-0.85; P = .01), adjusted for diagnosis and length of hospital stay. CONCLUSIONS Portable HEPA filters are effective in the prevention of IA. The cost of widespread portable HEPA filtration in hospitals will be more than offset by the decreases in nosocomial infections in general and in IA in particular.
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[Requirements for hygiene in the medical care of immunocompromised patients. Recommendations from the Committee for Hospital Hygiene and Infection Prevention at the Robert Koch Institute (RKI)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 53:357-88. [PMID: 20300719 PMCID: PMC7095954 DOI: 10.1007/s00103-010-1028-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Figueiredo Fonseca JDC, Bouakline A, Claisse JP, Feuilhade M, Baruchel A, Dombret H, Pavie J, Andrade Moreira ES, Derouin F, Lacroix C. Fungal contamination of water and water-related surfaces in three hospital wards with immunocompromised patients at risk for invasive fungal infections. J Infect Prev 2010. [DOI: 10.1177/1757177409358416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Studies suggest that hospital water supplies may serve as a reservoir for fungi and play a role in their spread. The objective of this study was to provide data on the fungal contamination of water, surfaces, and air of areas of water usage in three hospital wards that admit immunocompromised patients at risk for invasive fungal infection. Air, surface, and water samples were collected in patients’ rooms and water facilities of each ward. Analysis of 215 water samples show differences between wards in fungal recovery rates and isolated species, but Fusarium spp. were the predominant fungi. On the 838 surface samples, a similar fungal diversity was found and Fusarium spp. were the predominant fungi. Aspergillus spp. dominated among the moulds recovered from air. This study confirms that different moulds, mainly Fusarium spp., are present in water and surfaces and that prevention of the risk of nosocomial fungal infection should include a stringent maintenance and cleaning of water facilities.
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Affiliation(s)
| | - Adel Bouakline
- Unité Fonctionnelle de Lutte contre les Infections Nosocomiales (UFLIN), Hôpital Saint-Louis, APHP, Paris, France
| | - Jean-Pierre Claisse
- Unité Fonctionnelle de Lutte contre les Infections Nosocomiales (UFLIN), Hôpital Saint-Louis, APHP, Paris, France
| | - Martine Feuilhade
- Laboratoire de Parasitologie-Mycologie, Hôpital Saint-Louis, APHP, Paris, France, EA3520, Université Paris 7, Paris, France
| | - André Baruchel
- Service d'Hématologie pédiatrique, Hôpital Saint-Louis, APHP, Paris, France
| | - Hervé Dombret
- Service d'Hématologie adulte, Hôpital Saint-Louis, APHP, Paris, France
| | - Juliette Pavie
- Service des Maladies infectieuses et tropicales, Hôpital Saint-Louis, APHP, Paris, France
| | | | - Francis Derouin
- Laboratoire de Parasitologie-Mycologie, Hôpital Saint-Louis, APHP, Paris, France, EA3520, Université Paris 7, Paris, France
| | - Claire Lacroix
- Laboratoire de Parasitologie-Mycologie, Hôpital Saint-Louis, APHP, Paris, France, EA3520, Université Paris 7, Paris, France,
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91
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Ruiz-Camps I, Aguado JM, Almirante B, Bouza E, Ferrer Barbera C, Len O, López-Cerero L, Rodríguez-Tudela JL, Ruiz M, Solé A, Vallejo C, Vázquez L, Zaragoza R, Cuenca-Estrella M. Recomendaciones sobre la prevención de la infección fúngica invasora por hongos filamentosos de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC). Enferm Infecc Microbiol Clin 2010; 28:172.e1-172.e21. [DOI: 10.1016/j.eimc.2009.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 11/24/2009] [Indexed: 11/30/2022]
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92
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Cordeiro RA, Brilhante RS, Pantoja LD, Moreira Filho RE, Vieira PR, Rocha MF, Monteiro AJ, Sidrim JJ. Isolation of pathogenic yeasts in the air from hospital environments in the city of Fortaleza, northeast Brazil. Braz J Infect Dis 2010. [DOI: 10.1016/s1413-8670(10)70007-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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93
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Murali S, Langston A. Advances in antifungal prophylaxis and empiric therapy in patients with hematologic malignancies. Transpl Infect Dis 2009; 11:480-90. [DOI: 10.1111/j.1399-3062.2009.00441.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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94
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Brenier-Pinchart MP, Lebeau B, Quesada JL, Mallaret MR, Borel JL, Mollard A, Garban F, Brion JP, Molina L, Bosson JL, Cahn JY, Grillot R, Pelloux H. Influence of internal and outdoor factors on filamentous fungal flora in hematology wards. Am J Infect Control 2009; 37:631-7. [PMID: 19631408 DOI: 10.1016/j.ajic.2009.03.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 03/25/2009] [Accepted: 03/26/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nosocomial invasive filamentous fungi infections could result from inhalation of filamentous fungi conidia present in hospital environment. METHODS The environmental fungal flora in 3 different hospital wards with similar air conditioning was prospectively studied during 30 months and compared to internal (presence of agranulocytosis patient, behavioral practices, activity, cleaning work) and outdoor factors (meteorologic data, outdoor fungi). The general preventive measures differed from one unit to another. RESULTS The hematology wards with filamentous fungi preventive measures were significantly less contaminated than a conventional ward without specific measures. Internal and outdoor factors influenced the level of fungal flora. However, the influence of internal factors was greater in the conventional ward than in hematology wards. The variation of flora in the hospital environment was seasonal, and the level of this contamination in each ward was influenced by the meteorology. However, outdoor factors more readily explain the variations of fungal load in hematology than in the conventional ward. CONCLUSION This study highlights that specific preventive measures participate significantly in the control of the filamentous fungal flora intensity due to internal factors but not those due to outdoor factors, stressing the importance of high-efficiency particulate air filtration in high-risk units.
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95
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Brenier-Pinchart MP, Coussa-Rivière L, Lebeau B, Mallaret MR, Bulabois CE, Ducki S, Cahn JY, Grillot R, Pelloux H. Mobile air-decontamination unit and filamentous fungal load in the hematology ward: how efficient at the low-activity mode? Am J Infect Control 2009; 37:680-2. [PMID: 19362390 DOI: 10.1016/j.ajic.2008.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 12/23/2008] [Accepted: 12/29/2008] [Indexed: 11/17/2022]
Abstract
Air treatment with a mobile Plasmair air-decontamination unit significantly reduces the fungal spore load in hematology wards. We report that this system used at a low aspiration flow does not perform total biodecontamination against filamentous fungi. Moreover, the filamentous fungus load remaining in rooms equipped with this mobile air-decontamination unit is lowest in wards in which other preventive measures against nosocomial filamentous fungal infections are implemented.
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Affiliation(s)
- Marie-Pierre Brenier-Pinchart
- Parasitology and Mycology Laboratory, Grenoble Universitary Hospital and Joseph Fourier University, Grenoble, France.
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96
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Yoon YS, Lee CG. Partial purification and characterization of a novel antifungal compound against Aspergillus spp. from Synechocystis sp. PCC 6803. BIOTECHNOL BIOPROC E 2009. [DOI: 10.1007/s12257-009-0082-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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97
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Maschmeyer G, Neuburger S, Fritz L, Böhme A, Penack O, Schwerdtfeger R, Buchheidt D, Ludwig WD. A prospective, randomised study on the use of well-fitting masks for prevention of invasive aspergillosis in high-risk patients. Ann Oncol 2009; 20:1560-1564. [DOI: 10.1093/annonc/mdp034] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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98
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Melo LLSD, Lima AMC, Damasceno CAV, Vieira ALP. Flora fúngica no ambiente da Unidade de Terapia Intensiva Pediátrica e Neonatal em hospital terciário. REVISTA PAULISTA DE PEDIATRIA 2009. [DOI: 10.1590/s0103-05822009000300011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
OBJETIVO: As infecções nosocomiais são responsáveis por morbidade e mortalidade significativas no período neonatal. Considerando-se a preocupação com a qualidade do ar de áreas críticas como Unidades de Terapia Intensiva (UTI), foi realizado um levantamento da flora fúngica das UTI Pediátrica e Neonatal do Hospital das Clínicas Samuel Libânio, Pouso Alegre (MG), com a finalidade de identificar a presença de fungos potencialmente patogênicos e oportunistas. MÉTODOS: Foram realizadas 30 coletas, que incluíram leitos, incubadoras, janelas, aparelhos de ar condicionado, telefone, estetoscópios, portas e maçanetas. Placas de Agar Sabouraud Dextrose com o material das coletas foram incubadas em temperatura ambiente por 15 dias. A identificação foi baseada nas características macroscópicas no exame direto e em microcultivos. RESULTADOS: Fungos potencialmente patogênicos e toxigênicos foram isolados. A análise quantitativa das colônias revelou a presença de 11 gêneros. Verificou-se que mais de 40% das colônias correspondem ao gênero Penicillium spp, seguido por Cladosporium spp e Chrysosporium spp. CONCLUSÕES: Os fungos encontrados podem apresentar grande potencial de patogenicidade, principalmente em imunodeprimidos. É importante adotar medidas de controle ambiental, como assepsia dos equipamentos, controle da presença de visitantes, lavagem das mãos pelos funcionários e troca de filtros de ar condicionado.
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99
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Maschmeyer G. The changing face of febrile neutropenia-from monotherapy to moulds to mucositis. Prevention of mould infections. J Antimicrob Chemother 2009; 63 Suppl 1:i27-30. [PMID: 19372178 DOI: 10.1093/jac/dkp084] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Isolation of patients at risk of invasive mould infection might be suitable for the reduction of invasive aspergillosis or zygomycosis, if combined with high-efficiency particulate air filtration. Prophylactic wearing of filtering masks of N95 or FFP2 standards has not yet been demonstrated to be efficacious in reducing invasive mould infections outside of scenarios with excessive contamination of room air by fungal spore-loaded dust. The oral broad-spectrum antifungal azoles posaconazole and voriconazole offer protection against invasive Aspergillus infections in severely neutropenic leukaemia patients and allogeneic haematopoietic stem cell transplant recipients; however, their routine use might result not only in considerable side effects, but also in the spread of multi-azole-resistant Aspergillus species, so that careful selection of suitable high-risk patient populations is mandatory.
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Affiliation(s)
- Georg Maschmeyer
- Department of Haematology and Oncology, Klinikum Ernst von Bergmann, Potsdam 14467, Germany.
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100
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Sautour M, Sixt N, Dalle F, L'Ollivier C, Fourquenet V, Calinon C, Paul K, Valvin S, Maurel A, Aho S, Couillault G, Cachia C, Vagner O, Cuisenier B, Caillot D, Bonnin A. Profiles and seasonal distribution of airborne fungi in indoor and outdoor environments at a French hospital. THE SCIENCE OF THE TOTAL ENVIRONMENT 2009; 407:3766-71. [PMID: 19286244 DOI: 10.1016/j.scitotenv.2009.02.024] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 02/06/2009] [Accepted: 02/12/2009] [Indexed: 05/21/2023]
Abstract
A one-year prospective survey of fungal air contamination was conducted in outdoor air and inside two haematological units of a French hospital. Air was sampled with a portable Air System Impactor. During this period of survey, the mean viable fungal load was 122.1 cfu/m(3) in outdoor air samples, and 4.1 and 3.9 cfu/m(3) in samples from adult and pediatric haematology units, respectively. In outdoor samples, Cladosporium was the dominant genus (55%) while in the clinical units, Penicillium sp. (23 to 25%), Aspergillus sp. (15 to 23%) and Bjerkandera adusta (11 to 13%) were the most frequently recovered airborne fungi. The outdoor fungal load was far higher in autumn (168 cfu/m(3)), spring (110 cfu/m(3)) and summer (138 cfu/m(3)) than in winter (49 cfu/m(3)). In indoor air, fungal concentrations were significantly lower in winter (2.7 to 3.1 cfu/m(3)) than in summer (4.2 to 5.0 cfu/m(3)) in both haematology units. In the outdoor environment, Penicillium sp. and Aspergillus sp. were more abundant in winter while the levels of Cladosporium were lowest during this season. In the haematological units, the presence of Aspergillus sp. was stable during the year (close to 20%), Bjerkandera sp. was particularly abundant in winter (close to 30%); levels of Penicillium sp. were highest in autumn while levels of Cladosporium sp. were highest in spring and summer.
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Affiliation(s)
- Marc Sautour
- Parasitology and Mycology laboratory, CHU, Hôpital du Bocage, BP 77908, 21079 Dijon Cedex, France.
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