1
|
Gewecke A, Hare RK, Salgård C, Kyndi L, Høg M, Petersen G, Nahimana D, Abou-Chakra N, Knudsen JD, Rosendahl S, Vissing NH, Arendrup MC. A single-source nosocomial outbreak of Aspergillus flavus uncovered by genotyping. Microbiol Spectr 2024:e0027324. [PMID: 38888358 DOI: 10.1128/spectrum.00273-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/14/2024] [Indexed: 06/20/2024] Open
Abstract
During construction work (2017-2019), an increase in Aspergillus flavus infections was noted among pediatric patients, the majority of whom were receiving amphotericin B prophylaxis. Microsatellite genotyping was used to characterize the outbreak. A total of 153 A. flavus isolates of clinical and environmental origin were included. Clinical isolates included 140 from 119 patients. Eight patients were outbreak-related patients, whereas 111 were outbreak-unrelated patients from Danish hospitals (1994-2023). We further included four control strains. Nine A. flavus isolates were from subsequent air sampling in the outbreak ward (2022-2023). Typing followed Rudramurthy et al.(S. M. Rudramurthy, H. A. de Valk, A. Chakrabarti, J. Meis, and C. H. W. Klaassen, PLoS One 6:e16086, 2011, https://doi.org/10.1371/journal.pone.0016086). Minimum spanning tree (MST) and discriminant analysis of principal components (DAPC) were used for cluster analysis. DAPC analysis placed all 153 isolates in five clusters. Microsatellite marker pattern was clearly distinct for one cluster compared to the others. The same cluster was observed in an MST. This cluster included all outbreak isolates, air-sample isolates, and additional patient isolates from the outbreak hospital, previously undisclosed as outbreak related. The highest air prevalence of A. flavus was found in two technical risers of the outbreak ward, which were then sealed. Follow-up air samples were negative for A. flavus. Microsatellite typing defined the outbreak as nosocomial and facilitated the identification of an in-hospital source. Six months of follow-up air sampling was without A. flavus. Outbreak-related/non-related isolates were easily distinguished with DAPC and MST, as the outbreak clone's distinct marker pattern was delineated in both statistical analyses. Thus, it could be a variant of A. flavus, with a niche ability to thrive in the outbreak-hospital environment. IMPORTANCE Aspergillus flavus can cause severe infections and hospital outbreaks in immunocompromised individuals. Although lack of isogeneity does not preclude an outbreak, our study underlines the value of microsatellite genotyping in the setting of potential A. flavus outbreaks. Microsatellite genotyping documented an isogenic hospital outbreak with an internal source. This provided the "smoking gun" that prompted the rapid allocation of resources for thorough environmental sampling, the results of which guided immediate and relevant cleaning and source control measures. Consequently, we advise that vulnerable patients should be protected from exposure and that genotyping be included early in potential A. flavus outbreak investigations. Inspection and sampling are recommended at any site where airborne spores might disperse from. This includes rarely accessed areas where air communication to the hospital ward cannot be disregarded.
Collapse
Affiliation(s)
- A Gewecke
- Mycology Unit, Department for Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - R Krøger Hare
- Mycology Unit, Department for Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - C Salgård
- Department for Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - L Kyndi
- Department for Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - M Høg
- Department for Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - G Petersen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - D Nahimana
- Mycology Unit, Department for Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - N Abou-Chakra
- Mycology Unit, Department for Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - J D Knudsen
- Department for Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - S Rosendahl
- Section for Ecology and Evolution, Department for Biology, University of Copenhagen, Copenhagen, Denmark
| | - N H Vissing
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M C Arendrup
- Mycology Unit, Department for Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark
- Department for Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
- Department for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Chen F, Li Y, Wang W, Li J, Wang D, Sun X, Peng Y, Deng J. Comparative performance of contact plate metod and swab method for surface microbial contamination on medical fabrics. BMC Infect Dis 2024; 24:530. [PMID: 38802763 PMCID: PMC11129454 DOI: 10.1186/s12879-024-09416-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The contact plate method is widely accepted and used in various fields where hygiene and contamination levels are crucial. Evidence regarding the applicability of the contact plate method for sampling fabric microbial contamination levels in real medical environments was limited. This study aimed to assess the applicability of the contact plate method for detecting microbial contamination on medical fabrics in a real healthcare environment, thereby providing a benchmark for fabric microbial sampling methods. METHODS In a level three obstetrics ward of a hospital, twenty-four privacy curtains adjacent to patient beds were selected for this study. The contact plate and swab method were used to collect microbial samples from the privacy curtains on the 1st, 7th, 14th, and 28th days after they were hung. The total colony count on each privacy curtain surface was calculated, and microbial identification was performed. RESULTS After excluding the effects of time, room type, and curtain location on the detected microbial load, the linear mixed-effects model analysis showed that contact plate method yielded lower colony counts compared to swab method (P < 0.001). However, the contact plate method isolated more microbial species than swab method (P < 0.001). 291 pathogenic strains were isolated using the contact plate method and 133 pathogenic strains were isolated via the swab method. There was no difference between the two sampling methods in the detection of gram-negative bacteria (P = 0.089). Furthermore, the microbial load on curtains in double-occupancy rooms was lower than those in triple-occupancy rooms (P = 0.021), and the microbial load on curtains near windows was lower than that near doors (P = 0.004). CONCLUSION Contact plate method is superior to swab method in strain isolation. Swab method is more suitable for evaluating the bacterial contamination of fabrics.
Collapse
Affiliation(s)
- Feng Chen
- Department of Nosocomial Infection Management, West China Second University Hospital, Sichuan University, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
| | - Yaru Li
- Department of Nosocomial Infection Management, West China Second University Hospital, Sichuan University, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
| | - Wanqiu Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
- Department of medical administration, West China Second University Hospital, Sichuan University, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
| | - Juan Li
- Department of Nosocomial Infection Management, West China Second University Hospital, Sichuan University, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
| | - Dong Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
- Department of medical administration, West China Second University Hospital, Sichuan University, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
| | - Xiaxia Sun
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
- Department of medical administration, West China Second University Hospital, Sichuan University, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
| | - Yaping Peng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
- Department of medical administration, West China Second University Hospital, Sichuan University, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
| | - Jianjun Deng
- Department of Nosocomial Infection Management, West China Second University Hospital, Sichuan University, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China.
| |
Collapse
|
3
|
Orbay H, Ziembicki JA, Yassin M, Egro FM. Prevention and Management of Wound Infections in Burn Patients. Clin Plast Surg 2024; 51:255-265. [PMID: 38429048 DOI: 10.1016/j.cps.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
The leading cause of morbidity in burn patients is infection with pneumonia, urinary tract infection, cellulitis, and wound infection being the most common cause. High mortality is due to the immunocompromised status of patients and abundance of multidrug-resistant organisms in burn units. Despite the criteria set forth by American Association of Burn, the diagnosis and treatment of burn infections are not always straightforward. Topical antimicrobials, isolation, hygiene, and personal protective equipment are common preventive measures. Additionally medical and nutritional optimization of the patients is crucial to reverse the immunocompromised status triggered by burn injury.
Collapse
Affiliation(s)
- Hakan Orbay
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jenny A Ziembicki
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mohamed Yassin
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
| |
Collapse
|
4
|
Stavropoulou E, Huguenin A, Caruana G, Opota O, Perrottet N, Blanc DS, Grandbastien B, Senn L, Bochud PY, Lamoth F. Investigations of an increased incidence of non-Aspergillus invasive mould infections in an onco-haematology unit. Swiss Med Wkly 2024; 154:3730. [PMID: 38579310 DOI: 10.57187/s.3730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
AIMS OF THE STUDY Invasive mould infections are life-threatening complications in patients with haematologic cancer and chemotherapy-induced neutropenia. While invasive aspergillosis represents the main cause of invasive mould infections, non-Aspergillus mould infections, such as mucormycosis, are increasingly reported. Consequently, their local epidemiology should be closely monitored. The aim of this study was to investigate the causes of an increased incidence of non-Aspergillus mould infections in the onco-haematology unit of a Swiss tertiary care hospital. METHODS All cases of proven and probable invasive mould infections were retrospectively identified via a local registry for the period 2007-2021 and their incidence was calculated per 10,000 patient-days per year. The relative proportion of invasive aspergillosis and non-Aspergillus mould infections was assessed. Factors that may affect invasive mould infections' incidence, such as antifungal drug consumption, environmental contamination and changes in diagnostic approaches, were investigated. RESULTS A significant increase of the incidence of non-Aspergillus mould infections (mainly mucormycosis) was observed from 2017 onwards (Mann and Kendall test p = 0.0053), peaking in 2020 (8.62 episodes per 10,000 patient-days). The incidence of invasive aspergillosis remained stable across the period of observation. The proportion of non-Aspergillus mould infections increased significantly from 2017 (33% vs 16.8% for the periods 2017-2021 and 2007-2016, respectively, p = 0.02). Building projects on the hospital site were identified as possible contributors of this increase in non-Aspergillus mould infections. However, novel diagnostic procedures may have improved their detection. CONCLUSIONS We report a significant increase in non-Aspergillus mould infections, and mainly in mucormycosis infections, since 2017. There seems to be a multifactorial origin to this increase. Epidemiological trends of invasive mould infections should be carefully monitored in onco-haematology units in order to implement potential corrective measures.
Collapse
Affiliation(s)
- Elisavet Stavropoulou
- nfectious diseases service, Department of medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne Huguenin
- nfectious diseases service, Department of medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giorgia Caruana
- nfectious diseases service, Department of medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of microbiology, Department of laboratory medicine and pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Onya Opota
- Institute of microbiology, Department of laboratory medicine and pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nancy Perrottet
- Unit of clinical pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Dominique S Blanc
- Infection prevention and control unit, Infectious diseases Service, Department of medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bruno Grandbastien
- Infection prevention and control unit, Infectious diseases Service, Department of medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laurence Senn
- Infection prevention and control unit, Infectious diseases Service, Department of medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre-Yves Bochud
- Infectious diseases service, Department of medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frederic Lamoth
- Infectious diseases service, Department of medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of microbiology, Department of laboratory medicine and pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
5
|
Shah K, Deshpande M, Shah P. Healthcare-associated fungal infections and emerging pathogens during the COVID-19 pandemic. FRONTIERS IN FUNGAL BIOLOGY 2024; 5:1339911. [PMID: 38465254 PMCID: PMC10920311 DOI: 10.3389/ffunb.2024.1339911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/08/2024] [Indexed: 03/12/2024]
Abstract
Historically, fungi were mainly identified as plant and insect pathogens since they grow at 28°C. At the same time, bacteria are known to be the most common human pathogens as they are compatible with the host body temperature of 37°C. Because of immunocompromised hosts, cancer therapy, and malnutrition, fungi are rapidly gaining attention as human pathogens. Over 150 million people have severe fungal infections, which lead to approximately more than one million deaths per year. Moreover, diseases like cancer involving long-term therapy and prophylactic use of antifungal drugs in high-risk patients have increased the emergence of drug-resistant fungi, including highly virulent strains such as Candida auris. This clinical spectrum of fungal diseases ranges from superficial mucocutaneous lesions to more severe and life-threatening infections. This review article summarizes the effect of hospital environments, especially during the COVID-19 pandemic, on fungal infections and emerging pathogens. The review also provides insights into the various antifungal drugs and their existing challenges, thereby driving the need to search for novel antifungal agents.
Collapse
Affiliation(s)
- Krish Shah
- Biological Sciences Bellarmine College Preparatory, San Jose, CA, United States
| | | | - P. Shah
- Science Ambassador/Bio-Rad Laboratories, Hercules, CA, United States
| |
Collapse
|
6
|
Raposo Puglia D, Raposo Puglia JÁ, García-Cabrera E, Morales F, Camacho-Vega JC, Vilches-Arenas Á. Risk Factors and Environmental Preventive Actions for Aspergillosis in Patients with Hematological Malignancies. Clin Pract 2024; 14:280-292. [PMID: 38391408 PMCID: PMC10888107 DOI: 10.3390/clinpract14010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
(1) Background: Aspergillus spp. is a widely distributed filamentous fungus in the environment due to its high sporulation capacity. Currently, invasive aspergillosis (IA) is the most common invasive fungal infection in patients with hematologic malignancies, with high rates of mortality and morbidity. The multifactorial nature of the disease requires appropriate risk stratification to enable the most appropriate preventive measures to be adapted and implemented according to the characteristics of the patient. In this sense, the present research aims to identify recent risk factors and environmental control measures against invasive aspergillosis to establish preventive actions to reduce the incidence of invasive aspergillosis in hospitals. (2) Methods: We conducted a qualitative systematic review of the scientific literature on environmental risk factors and preventive measures for invasive aspergillosis in patients with hematologic malignancies. The Medline, Cochrane, and Scopus databases were consulted, following the PRISMA and STROBE guidelines. (3) Results: Adequate implementation of environmental control measures is presented as the most efficient intervention in terms of prevention to decrease the incidence of invasive aspergillosis in hospitals. Neutropenia, fungal contamination, insufficient environmental control measures in hospital and home settings, length of hospital stay, and anemia, are identified as independent risk factors. We show that HEPA, LAF, and Plasmair® systems are suitable methods to reduce the concentration of airborne fungal spores. Antifungal prophylaxis did not significantly influence IA reduction in our study. (4) Conclusions: Proper professional training and environmental control measures in hospitals are essential for the prevention of invasive aspergillosis. We should optimize risk stratification for patients with hematologic malignancies. Antifungal prophylaxis should be complementary to environmental control measures and should never be substituted for the latter. Studies should also be undertaken to evaluate the efficiency of environmental control measures against IA at patients' homes.
Collapse
Affiliation(s)
- Daniel Raposo Puglia
- Department of General and Digestive Surgery, Hospital Universitario Jerez de la Frontera, Ronda de Circunvalación s/n, 11407 Jerez de la Frontera, Spain
| | - José Ángel Raposo Puglia
- Department of Hematology, Hospital Universitario Puerta del Mar, Ana de Viya, 21, 11009 Cádiz, Spain
| | - Emilio García-Cabrera
- Preventive Medicine and Public Health Department, Faculty of Medicine, University of Seville, Av. Sanchez Pizjuan s/n, 41009 Seville, Spain
| | - Fátima Morales
- Preventive Medicine and Public Health Department, Faculty of Medicine, University of Seville, Av. Sanchez Pizjuan s/n, 41009 Seville, Spain
| | - Juan Carlos Camacho-Vega
- Department of Building Constructions II, Higher Technical School of Building Engineering, University of Seville, Avda. de la Reina Mercedes, 4A, 41012 Seville, Spain
- Occupational Risk Prevention Unit, Virgen Macarena Hospital, Avda. Dr. Fedriani 3, 41009 Seville, Spain
| | - Ángel Vilches-Arenas
- Preventive Medicine and Public Health Department, Faculty of Medicine, University of Seville, Av. Sanchez Pizjuan s/n, 41009 Seville, Spain
- Department of Preventive Medicine, Virgen Macarena Hospital, Avda. Dr. Fedriani 3, 41009 Seville, Spain
| |
Collapse
|
7
|
Hiel SJP, Hendriks ACA, Eijkenboom JJA, Bosch T, Coolen JPM, Melchers WJG, Anröchte P, Camps SMT, Verweij PE, Zhang J, van Dommelen L. Aspergillus Outbreak in an Intensive Care Unit: Source Analysis with Whole Genome Sequencing and Short Tandem Repeats. J Fungi (Basel) 2024; 10:51. [PMID: 38248960 PMCID: PMC10817286 DOI: 10.3390/jof10010051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/17/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024] Open
Abstract
Whole genome sequencing (WGS) is widely used for outbreak analysis of bacteriology and virology but is scarcely used in mycology. Here, we used WGS for genotyping Aspergillus fumigatus isolates from a potential Aspergillus outbreak in an intensive care unit (ICU) during construction work. After detecting the outbreak, fungal cultures were performed on all surveillance and/or patient respiratory samples. Environmental samples were obtained throughout the ICU. WGS was performed on 30 isolates, of which six patient samples and four environmental samples were related to the outbreak, and twenty samples were unrelated, using the Illumina NextSeq 550. A SNP-based phylogenetic tree was created from outbreak samples and unrelated samples. Comparative analysis (WGS and short tandem repeats (STRs), microsatellite loci analysis) showed that none of the strains were related to each other. The lack of genetic similarity suggests the accumulation of Aspergillus spores in the hospital environment, rather than a single source that supported growth and reproduction of Aspergillus fumigatus. This supports the hypothesis that the Aspergillus outbreak was likely caused by release of Aspergillus fumigatus spores during construction work. Indeed, no new Aspergillus cases were observed in the ICU after cessation of construction. This study demonstrates that WGS is a suitable technique for examining inter-strain relatedness of Aspergillus fumigatus in the setting of an outbreak investigation.
Collapse
Affiliation(s)
- Stephan J. P. Hiel
- Department of Intensive Care, Máxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Amber C. A. Hendriks
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
- Department of Medical Microbiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Jos J. A. Eijkenboom
- Department of Intensive Care, Máxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Thijs Bosch
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Jordy P. M. Coolen
- Department of Medical Microbiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Willem J. G. Melchers
- Department of Medical Microbiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Paul Anröchte
- Department of Infection Prevention and Control, Máxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Simone M. T. Camps
- Department of Infection Prevention and Control, Máxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Paul E. Verweij
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
- Department of Medical Microbiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Jianhua Zhang
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Laura van Dommelen
- Stichting PAMM, Laboratory of Medical Microbiology, De Run 6250, 5504 DL Veldhoven, The Netherlands
| |
Collapse
|
8
|
Venice F, Spina F, Davolos D, Ghignone S, Varese GC. The genomes of Scedosporium between environmental challenges and opportunism. IMA Fungus 2023; 14:25. [PMID: 38049914 PMCID: PMC10694956 DOI: 10.1186/s43008-023-00128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 11/05/2023] [Indexed: 12/06/2023] Open
Abstract
Emerging fungal pathogens are a global challenge for humankind. Many efforts have been made to understand the mechanisms underlying pathogenicity in bacteria, and OMICs techniques are largely responsible for those advancements. By contrast, our limited understanding of opportunism and antifungal resistance is preventing us from identifying, limiting and interpreting the emergence of fungal pathogens. The genus Scedosporium (Microascaceae) includes fungi with high tolerance to environmental pollution, whilst some species can be considered major human pathogens, such as Scedosporium apiospermum and Scedosporium boydii. However, unlike other fungal pathogens, little is known about the genome evolution of these organisms. We sequenced two novel genomes of Scedosporium aurantiacum and Scedosporium minutisporum isolated from extreme, strongly anthropized environments. We compared all the available Scedosporium and Microascaceae genomes, that we systematically annotated and characterized ex novo in most cases. The genomes in this family were integrated in a Phylum-level comparison to infer the presence of putative, shared genomic traits in filamentous ascomycetes with pathogenic potential. The analysis included the genomes of 100 environmental and clinical fungi, revealing poor evolutionary convergence of putative pathogenicity traits. By contrast, several features in Microascaceae and Scedosporium were detected that might have a dual role in responding to environmental challenges and allowing colonization of the human body, including chitin, melanin and other cell wall related genes, proteases, glutaredoxins and magnesium transporters. We found these gene families to be impacted by expansions, orthologous transposon insertions, and point mutations. With RNA-seq, we demonstrated that most of these anciently impacted genomic features responded to the stress imposed by an antifungal compound (voriconazole) in the two environmental strains S. aurantiacum MUT6114 and S. minutisporum MUT6113. Therefore, the present genomics and transcriptomics investigation stands on the edge between stress resistance and pathogenic potential, to elucidate whether fungi were pre-adapted to infect humans. We highlight the strengths and limitations of genomics applied to opportunistic human pathogens, the multifactoriality of pathogenicity and resistance to drugs, and suggest a scenario where pressures other than anthropic contributed to forge filamentous human pathogens.
Collapse
Affiliation(s)
- Francesco Venice
- Department of Life Sciences and System Biology, University of Turin, Viale Mattioli 25, 10125, Turin, Italy
| | - Federica Spina
- Department of Life Sciences and System Biology, University of Turin, Viale Mattioli 25, 10125, Turin, Italy
| | - Domenico Davolos
- Department of Technological Innovations and Safety of Plants, Products and Anthropic Settlements (DIT), INAIL, Research Area, Via R. Ferruzzi 38/40, 00143, Rome, Italy
| | - Stefano Ghignone
- Institute for Sustainable Plant Protection (IPSP), SS Turin-National Research Council (CNR), Viale Mattioli 25, 10125, Turin, Italy
| | - Giovanna Cristina Varese
- Department of Life Sciences and System Biology, University of Turin, Viale Mattioli 25, 10125, Turin, Italy.
| |
Collapse
|
9
|
Douglas AP, Stewart AG, Halliday CL, Chen SCA. Outbreaks of Fungal Infections in Hospitals: Epidemiology, Detection, and Management. J Fungi (Basel) 2023; 9:1059. [PMID: 37998865 PMCID: PMC10672668 DOI: 10.3390/jof9111059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
Nosocomial clusters of fungal infections, whilst uncommon, cannot be predicted and are associated with significant morbidity and mortality. Here, we review reports of nosocomial outbreaks of invasive fungal disease to glean insight into their epidemiology, risks for infection, methods employed in outbreak detection including genomic testing to confirm the outbreak, and approaches to clinical and infection control management. Both yeasts and filamentous fungi cause outbreaks, with each having general and specific risks. The early detection and confirmation of the outbreak are essential for diagnosis, treatment of affected patients, and termination of the outbreak. Environmental sampling, including the air in mould outbreaks, for the pathogen may be indicated. The genetic analysis of epidemiologically linked isolates is strongly recommended through a sufficiently discriminatory approach such as whole genome sequencing or a method that is acceptably discriminatory for that pathogen. An analysis of both linked isolates and epidemiologically unrelated strains is required to enable genetic similarity comparisons. The management of the outbreak encompasses input from a multi-disciplinary team with epidemiological investigation and infection control measures, including screening for additional cases, patient cohorting, and strict hygiene and cleaning procedures. Automated methods for fungal infection surveillance would greatly aid earlier outbreak detection and should be a focus of research.
Collapse
Affiliation(s)
- Abby P. Douglas
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC 3084, Australia
| | - Adam G. Stewart
- Centre for Clinical Research, Faculty of Medicine, Royal Brisbane and Women’s Hospital Campus, The University of Queensland, Herston, QLD 4006, Australia;
| | - Catriona L. Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, NSW 2145, Australia; (C.L.H.); (S.C.-A.C.)
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, NSW 2145, Australia; (C.L.H.); (S.C.-A.C.)
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| |
Collapse
|
10
|
Kanaujia R, Singh S, Rudramurthy SM. Aspergillosis: an Update on Clinical Spectrum, Diagnostic Schemes, and Management. CURRENT FUNGAL INFECTION REPORTS 2023; 17:1-12. [PMID: 37360858 PMCID: PMC10157594 DOI: 10.1007/s12281-023-00461-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review This review gives an overview of the diseases caused by Aspergillus, including a description of the species involved and the infected clinical systems. We provide insight into the various diagnostic methods available for diagnosing aspergillosis, particularly invasive aspergillosis (IA), including the role of radiology, bronchoscopy, culture, and non-culture-based microbiological methods. We also discuss the available diagnostic algorithms for the different disease conditions. This review also summarizes the main aspects of managing infections due to Aspergillus spp., such as antifungal resistance, choice of antifungals, therapeutic drug monitoring, and new antifungal alternatives. Recent Findings The risk factors for this infection continue to evolve with the development of many biological agents that target the immune system and the increase of viral illnesses such as coronavirus disease. Due to the limitations of present mycological test methods, establishing a fast diagnosis is frequently difficult, and reports of developing antifungal resistance further complicate the management of aspergillosis. Many commercial assays, like AsperGenius®, MycAssay Aspergillus®, and MycoGENIE®, have the advantage of better species-level identification and concomitant resistance-associated mutations. Fosmanogepix, ibrexafungerp, rezafungin, and olorofim are newer antifungal agents in the pipeline exhibiting remarkable activity against Aspergillus spp. Summary The fungus Aspergillus is found ubiquitously around the world and can cause various infections, from harmless saprophytic colonization to severe IA. Understanding the diagnostic criteria to be used in different patient groups and the local epidemiological data and antifungal susceptibility profile is critical for optimal patient management.
Collapse
Affiliation(s)
- Rimjhim Kanaujia
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research PGIMER, Chandigarh, India
| | - Shreya Singh
- Department of Microbiology, Dr B R Ambedkar State Institute of Medical Sciences (AIMS), Mohali, Punjab India
| | - Shivaprakash M. Rudramurthy
- Mycology Division, Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research PGIMER, Chandigarh, India
| |
Collapse
|
11
|
Benedict K, Jackson BR, Toda M. Diagnosis Codes for Mold Infections and Mold Exposure Before and After Hurricane Harvey Among a Commercially Insured Population-Houston, Texas, 2016-2018. Disaster Med Public Health Prep 2023; 17:e504. [PMID: 36927602 PMCID: PMC10640901 DOI: 10.1017/dmp.2023.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Indoor mold after flooding poses health risks, including rare but serious invasive mold infections. The purpose of this study was to evaluate use of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes for mold infection and mold exposure in Houston, Texas, during the year before and the year after Hurricane Harvey. METHODS This study used data from MarketScan, a large health insurance claims database. RESULTS The incidence of invasive mold infections remained unchanged in the year after Hurricane Harvey; however, the incidence of diagnosis codes for mold exposure nearly doubled compared with the year before the hurricane (6.3 vs 11.0 per 100 000 enrollees, rate ratio: 1.7, 95% confidence interval 1.0-3.1). CONCLUSIONS Diagnosis codes alone may not be sufficiently sensitive to detect changes in invasive mold infection rates within this population and time frame, demonstrating the need for more comprehensive studies.
Collapse
Affiliation(s)
| | | | - Mitsuru Toda
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
12
|
What's New in Prevention of Invasive Fungal Diseases during Hospital Construction and Renovation Work: An Overview. J Fungi (Basel) 2023; 9:jof9020151. [PMID: 36836266 PMCID: PMC9966904 DOI: 10.3390/jof9020151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/25/2023] Open
Abstract
The goal of the overview was to give insight into the recent data of invasive fungal diseases (IFDs) associated with construction and renovation in healthcare settings as well as the recent evidence about available prevention and infection control measures. The number of studies describing IFD outbreaks associated with construction or renovation is on the rise again. Applying adequate prevention measures is still a challenge not just for healthcare workers but also for architects and construction workers as well. The role of multidisciplinary teams in the planning and monitoring of prevention measures cannot be overemphasized. Dust control is an inevitable part of every prevention plan. HEPA filters are helpful in the prevention of fungal outbreaks in hematologic patients, but further studies are needed to clarify the extent in which they contribute as specific control measures. The cut-off value for a "threating" level of fungal spore contamination still remains to be defined. The value of antifungal prophylaxis is difficult to assess because other preventive measures are simultaneously applied. Recommendations are still based on few meta-analyses, a large number of descriptive reports, and the opinion of respective authorities. Outbreak reports in the literature are a valuable resource and should be used for education as well as for preparing outbreak investigations.
Collapse
|
13
|
Molo MS, White JB, Cornish V, Gell RM, Baars O, Singh R, Carbone MA, Isakeit T, Wise KA, Woloshuk CP, Bluhm BH, Horn BW, Heiniger RW, Carbone I. Asymmetrical lineage introgression and recombination in populations of Aspergillus flavus: Implications for biological control. PLoS One 2022; 17:e0276556. [PMID: 36301851 PMCID: PMC9620740 DOI: 10.1371/journal.pone.0276556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/08/2022] [Indexed: 11/23/2022] Open
Abstract
Aspergillus flavus is an agriculturally important fungus that causes ear rot of maize and produces aflatoxins, of which B1 is the most carcinogenic naturally-produced compound. In the US, the management of aflatoxins includes the deployment of biological control agents that comprise two nonaflatoxigenic A. flavus strains, either Afla-Guard (member of lineage IB) or AF36 (lineage IC). We used genotyping-by-sequencing to examine the influence of both biocontrol agents on native populations of A. flavus in cornfields in Texas, North Carolina, Arkansas, and Indiana. This study examined up to 27,529 single-nucleotide polymorphisms (SNPs) in a total of 815 A. flavus isolates, and 353 genome-wide haplotypes sampled before biocontrol application, three months after biocontrol application, and up to three years after initial application. Here, we report that the two distinct A. flavus evolutionary lineages IB and IC differ significantly in their frequency distributions across states. We provide evidence of increased unidirectional gene flow from lineage IB into IC, inferred to be due to the applied Afla-Guard biocontrol strain. Genetic exchange and recombination of biocontrol strains with native strains was detected in as little as three months after biocontrol application and up to one and three years later. There was limited inter-lineage migration in the untreated fields. These findings suggest that biocontrol products that include strains from lineage IB offer the greatest potential for sustained reductions in aflatoxin levels over several years. This knowledge has important implications for developing new biocontrol strategies.
Collapse
Affiliation(s)
- Megan S. Molo
- Department of Entomology and Plant Pathology, Center for Integrated
Fungal Research, North Carolina State University, Raleigh, NC, United States of
America
| | - James B. White
- Department of Entomology and Plant Pathology, Center for Integrated
Fungal Research, North Carolina State University, Raleigh, NC, United States of
America
| | - Vicki Cornish
- Department of Entomology and Plant Pathology, Center for Integrated
Fungal Research, North Carolina State University, Raleigh, NC, United States of
America
| | - Richard M. Gell
- Department of Entomology and Plant Pathology, Center for Integrated
Fungal Research, North Carolina State University, Raleigh, NC, United States of
America
- Program of Genetics, North Carolina State University, Raleigh, North
Carolina, United States of America
| | - Oliver Baars
- Department of Entomology and Plant Pathology, Center for Integrated
Fungal Research, North Carolina State University, Raleigh, NC, United States of
America
| | - Rakhi Singh
- Department of Entomology and Plant Pathology, Center for Integrated
Fungal Research, North Carolina State University, Raleigh, NC, United States of
America
| | - Mary Anna Carbone
- Center for Integrated Fungal Research and Department of Plant and
Microbial Biology, North Carolina State University, Raleigh, NC, United States
of America
| | - Thomas Isakeit
- Department of Plant Pathology and Microbiology, Texas AgriLife Extension
Service, Texas A&M University, College Station, TX, United States of
America
| | - Kiersten A. Wise
- Department of Plant Pathology, University of Kentucky, Princeton, KY,
United States of America
| | - Charles P. Woloshuk
- Department of Plant Pathology and Botany, Purdue University, West
Lafayette, IN, United States of America
| | - Burton H. Bluhm
- University of Arkansas Division of Agriculture, Department of Entomology
and Plant Pathology, Fayetteville, AR, United States of
America
| | - Bruce W. Horn
- United States Department of Agriculture, Agriculture Research Service,
Dawson, GA, United States of America
| | - Ron W. Heiniger
- Department of Crop and Soil Sciences, North Carolina State University,
Raleigh, NC, United States of America
| | - Ignazio Carbone
- Department of Entomology and Plant Pathology, Center for Integrated
Fungal Research, North Carolina State University, Raleigh, NC, United States of
America
- Program of Genetics, North Carolina State University, Raleigh, North
Carolina, United States of America
- * E-mail:
| |
Collapse
|
14
|
Evaluation of indoor airborne fungal concentration in haematologic wards over a 2 year period. J Hosp Infect 2022; 127:129-130. [PMID: 35840000 DOI: 10.1016/j.jhin.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/22/2022]
|
15
|
Air Sampling for Fungus around Hospitalized Patients with Coronavirus Disease 2019. J Fungi (Basel) 2022; 8:jof8070692. [PMID: 35887448 PMCID: PMC9321969 DOI: 10.3390/jof8070692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022] Open
Abstract
The risk of developing coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) depends on factors related to the host, virus, and treatment. However, many hospitals have modified their existing rooms and adjusted airflow to protect healthcare workers from aerosolization, which may increase the risk of Aspergillus exposure. This study aimed to quantitatively investigate airborne fungal levels in negative and slightly negative pressure rooms for COVID-19 patients. The air in neutral pressure rooms in ordinary wards and a liver intensive care unit with high-efficiency particulate air filter was also assessed for comparison. We found the highest airborne fungal burden in recently renovated slightly negative air pressure rooms, and a higher airborne fungal concentration in both areas used to treat COVID-19 patients. The result provided evidence of the potential environmental risk of CAPA by quantitative microbiologic air sampling, which was scarcely addressed in the literature. Enhancing environmental infection control measures to minimize exposure to fungal spores should be considered. However, the clinical implications of a periodic basis to determine indoor airborne fungal levels and further air sterilization in these areas remain to be defined.
Collapse
|
16
|
Sathitakorn O, Chaononghin S, Katawethiwong P, Pientong T, Weber DJ, Warren DK, Apisarnthanarak P, Apisarnthanarak A. Strategies to limit invasive fungal infection in a coronavirus disease 2019 (COVID-19) intensive care unit: The role of infection prevention for renovation and construction in resource-limited settings. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e74. [PMID: 36483387 PMCID: PMC9726591 DOI: 10.1017/ash.2022.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 06/17/2023]
Abstract
Hospital construction and renovation activities are the main cause of healthcare-associated fungal outbreaks. Infection control risk assessments (ICRAs) for renovation and construction decrease the risk of healthcare-associated fungal outbreaks, but they are typically not performed in developing countries. We reviewed an outbreak investigation to limit the construction-related fungal infections in a COVID-19 ICU in a resource-limited setting.
Collapse
Affiliation(s)
- Ornnicha Sathitakorn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Prathum Thani, Thailand
| | - Surachai Chaononghin
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Prathum Thani, Thailand
| | - Panipak Katawethiwong
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Prathum Thani, Thailand
| | - Thanus Pientong
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Prathum Thani, Thailand
| | - David J. Weber
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - David K. Warren
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Piyaporn Apisarnthanarak
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Prathum Thani, Thailand
| |
Collapse
|
17
|
Infection prevention requirements for the medical care of immunosuppressed patients: recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. GMS HYGIENE AND INFECTION CONTROL 2022; 17:Doc07. [PMID: 35707229 PMCID: PMC9174886 DOI: 10.3205/dgkh000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Germany, guidelines for hygiene in hospitals are given in form of recommendations by the Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention, "KRINKO"). The KRINKO and its voluntary work are legitimized by the mandate according to § 23 of the Infection Protection Act (Infektionsschutzgesetz, "IfSG"). The original German version of this document was published in February 2021 and has now been made available to the international professional public in English. The guideline provides recommendations on infection prevention and control for immunocompromised individuals in health care facilities. This recommendation addresses not only measures related to direct medical care of immunocompromised patients, but also management aspects such as surveillance, screening, antibiotic stewardship, and technical/structural aspects such as patient rooms, air quality, and special measures during renovations.
Collapse
|
18
|
Inkster T, Peters C, Dancer S. Safe design and maintenance of bone marrow transplant units: a narrative review. Clin Microbiol Infect 2022; 28:1091-1096. [DOI: 10.1016/j.cmi.2022.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 11/03/2022]
|
19
|
Chiou CA, Yoon MK. An Update on Fungal Orbital Infections. Int Ophthalmol Clin 2022; 62:55-69. [PMID: 35325910 DOI: 10.1097/iio.0000000000000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Routine Surveillance of Healthcare-Associated Infections Misses a Significant Proportion of Invasive Aspergillosis in Patients with Severe COVID-19. J Fungi (Basel) 2022; 8:jof8030273. [PMID: 35330275 PMCID: PMC8954197 DOI: 10.3390/jof8030273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 11/17/2022] Open
Abstract
Rates of invasive aspergillosis (IA) among COVID-19 ICU patients seem to reach over 30% in certain settings. At Vienna General Hospital (VGH), all rooms in COVID-19 ICUs were put under negative pressure as a protective measure, thus increasing the risk of exposure to environmental pathogens for patients. Even though all ICU patients are surveilled for healthcare-associated infections (HAI), there were concerns that the routine protocol might not be sufficient for IA detection. We reviewed the electronic patient charts of all patients with COVID-19 admitted to ICUs between 1 March 2020 and 31 July 2021 for fungal co- or superinfections, comparing four diagnostic algorithms based on different recommendations for the diagnosis of IA (according to EORTC/MSG, BM-AspICU, IAPA and CAPA) to our routine surveillance protocol. We found that out of 252 patients who were admitted to the ICU during the study period, 25 (9.9%) fulfilled the criteria of probable or possible IA of at least one algorithm. The IAPA definitions detected 25 and the CAPA definition 23 probable and 2 possible cases, out of which only 16 were classified as hospital-acquired IA by routine surveillance. In conclusion, adjustment of the routine protocol using a classification system especially designed for respiratory viral illness seems useful for the surveillance of IA in a highly vulnerable patient cohort.
Collapse
|
21
|
Almansob A, Bahkali AH, Ameen F. Efficacy of Gold Nanoparticles against Drug-Resistant Nosocomial Fungal Pathogens and Their Extracellular Enzymes: Resistance Profiling towards Established Antifungal Agents. NANOMATERIALS 2022; 12:nano12050814. [PMID: 35269303 PMCID: PMC8912448 DOI: 10.3390/nano12050814] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023]
Abstract
Drug resistance of filamentous fungi to the commonly used antifungal agents is a major concern in medicine. Therefore, an effective approach to treat several opportunistic fungal infections is the need of the hour. Mentha piperita is used in home remedies to treat different disorders. Isolates of fungi were taken from hospitals in Riyadh, Saudi Arabia, and identified using molecular tools. Amphotericin B, Voriconazole, and Micafungin were applied to screen the resistance of these isolates using both disc and broth microdilution techniques. An aqueous extract of Mentha piperita was utilized to synthesize AuNPs and the nanoparticles were characterized using UV-Vis, FTIR, TEM, EDAX, and XRD. The AuNPs were tested for antifungal activity against the nosocomial fungal pathogens and the activity of extracellular enzymes of such pathogens were analyzed after treatment with AuNPs. We conclude that AuNPs synthesized using Mentha piperita do not possess especially effective antifungal properties against multi-drug resistant Aspergillus species. Five out of eighteen isolates were inhibited by AuNPs. When inhibition was observed, significant alterations in the activity profile of extracellular enzymes of the nosocomial fungi were observed.
Collapse
|
22
|
Yousefzadeh A, Maleki A, Athar SD, Darvishi E, Ahmadi M, Mohammadi E, Tang VT, Kalmarzi RN, Kashefi H. Evaluation of bio-aerosols type, density, and modeling of dispersion in inside and outside of different wards of educational hospital. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:14143-14157. [PMID: 34601681 PMCID: PMC8487404 DOI: 10.1007/s11356-021-16733-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
Exposure to bioaerosols in the air of hospitals is associated with a wide range of adverse health effects due to the presence of airborne microorganisms. Intensity and type of health effects depend on many factors such as the type, density, and diversity of bioaerosols in hospital environments. Therefore, identifying and determining their distribution in hospital environment contribute to reduce their adverse effects and maintain the physical health of patients and staff, as well as find the source of infections and possible allergies due to the presence of bioaerosols. Therefore, the present study was conducted to determine the type and concentration of the bacterial and fungal bioaerosols, and their distribution in the indoor and outdoor air of a teaching hospital to establish a reference for future studies or measures. The air samples were collected with a one-stage Anderson sampler and particle mass counter for a period of four months in the fall and winter of 2019. In total, 262 bacterial and fungal samples were collected from the air of the wards of Tohid Hospital, Sanandaj, Iran. Antibiotic resistance test, bacterial identification by PCR method, and modeling the dispersion of concentrations of bio-aerosols were also conducted. In order to identify bacteria and fungi, some biochemical and molecular tests and microscopic and macroscopic characteristic methods were applied, respectively. The results showed that the highest and lowest densities of the bioaerosols were observed in lung and operating wards (336.67 and 15.25 CFU/m3). Moreover, the highest and least concentrations of particles were seen in the emergency and operating wards, respectively. The most common fungi isolated from the hospital air were Penicillium (24.7%), Cladosporium (23. 4%), Aspergillus niger (13.3%), and Aspergillus Flavus (11.4%). Furthermore, the highest concentration of the isolated bacterium was Staphylococcus hemolyticus (31.84%). Most bacteria showed the highest resistance to gentamicin. The overall average hospital air pollution to bioaerosols was slightly higher than the standards proposed by international organizations. Due to the high concentration of bioaerosols and particles in the studied hospital, providing suitable conditions such as temperature, humidity, proper ventilation, and intelligent air conditioning system using efficient ventilation systems, and restricting the entrance of wards can reduce airborne particles in hospital environment.
Collapse
Affiliation(s)
- Ameneh Yousefzadeh
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Afshin Maleki
- Environmental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Saeed Dehestani Athar
- Environmental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ebrahim Darvishi
- Environmental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Manochehr Ahmadi
- Department of Microbiology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ebrahim Mohammadi
- Environmental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Van Tai Tang
- Faculty of Environment and Labour Safety, Ton Duc Thang University, Ho Chi Minh City, Vietnam
| | - Rasoul Nassiri Kalmarzi
- Department of Internal Medicine, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Hajar Kashefi
- Environmental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| |
Collapse
|
23
|
Subroto E, van Neer J, Valdes I, de Cock H. Growth of Aspergillus fumigatus in Biofilms in Comparison to Candida albicans. J Fungi (Basel) 2022; 8:48. [PMID: 35049988 PMCID: PMC8779434 DOI: 10.3390/jof8010048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 12/18/2022] Open
Abstract
Biofilm formation during infections with the opportunistic pathogen Aspergillus fumigatus can be very problematic in clinical settings, since it provides the fungal cells with a protective environment. Resistance against drug treatments, immune recognition as well as adaptation to the host environment allows fungal survival in the host. The exact molecular mechanisms behind most processes in the formation of biofilms are unclear. In general, the formation of biofilms can be categorized roughly in a few stages; adhesion, conidial germination and development of hyphae, biofilm maturation and cell dispersion. Fungi in biofilms can adapt to the in-host environment. These adaptations can occur on a level of phenotypic plasticity via gene regulation. However, also more substantial genetic changes of the genome can result in increased resistance and adaptation in the host, enhancing the survival chances of fungi in biofilms. Most research has focused on the development of biofilms. However, to tackle developing microbial resistance and adaptation in biofilms, more insight in mechanisms behind genetic adaptations is required to predict which defense mechanisms can be expected. This can be helpful in the development of novel and more targeted antifungal treatments to combat fungal infections.
Collapse
Affiliation(s)
| | | | | | - Hans de Cock
- Molecular Microbiology Laboratory, Department of Biology, Faculty of Science, Utrecht University, Padualaan 8, 3584 CH Utrecht, The Netherlands; (E.S.); (J.v.N.); (I.V.)
| |
Collapse
|
24
|
Al-Rubaey NF, Hussain H, Ibraheem N, Radhi M, Hindi NK, AL-Jubori RK. A review of airborne contaminated microorganisms associated with human diseases. MEDICAL JOURNAL OF BABYLON 2022. [DOI: 10.4103/mjbl.mjbl_20_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
25
|
Pathania V, Shankar P, Kaur K, Vashisht D, Kashif AW, Kothari R. Cutaneous aspergillosis presenting as surgical site infection. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_451_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
26
|
Büchner F, Hoffman M, Dobermann UH, Edel B, Lehmann T, Kipp F. Do closed waste containers lead to less air contamination than opened? A clinical case study at Jena University Hospital, Germany. WASTE MANAGEMENT (NEW YORK, N.Y.) 2021; 136:11-17. [PMID: 34634566 DOI: 10.1016/j.wasman.2021.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/13/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
Nosocomial infections are a growing challenge at hospitals. This clinical study aimed to investigate the influence of waste container construction ((open (O), closed (C), and hands-free opening (HF)) on microbial air contamination in a hospital setting. The results are intended to help develop guidelines for waste containers for the collection of non-infectious waste at hospitals and medical facilities. The clinical experiment was conducted at the University Hospital Jena, Germany. Air Impactor samples were performed and microbiologically evaluated for bacteria and fungi both quantitatively and qualitatively. The results were statistically determined using generalized estimating equations. Quantitatively, the lowest bacterial counts in ambient air were found around closed waste containers (114.74 CFU/m3) in comparison to HF (129.28 CFU/m3) and O (126.28 CFU/m3). For fungi, the surrounding air of C (2.08 CFU/m3) and HF (1.97 CFU/m3) waste containers showed a lower impact of fungal air contamination than for O (2.32 CFU/m3). Overall, it was shown that C are more preferable to HF and O waste containers from the point of view of microbial air contamination at hospitals.
Collapse
Affiliation(s)
- Franziskus Büchner
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, D-07747 Jena, Germany.
| | - Marc Hoffman
- Integrative Health and Security Management Center, Staff Section Environmental Protection, Jena University Hospital, Bachstraße 18, D-07743 Jena, Germany
| | - Ute-Helke Dobermann
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, D-07747 Jena, Germany
| | - Birgit Edel
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, D-07747 Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Bachstraße 18, D-07743 Jena, Germany
| | - Frank Kipp
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, D-07747 Jena, Germany
| |
Collapse
|
27
|
Suleyman G, Alangaden GJ. Nosocomial Fungal Infections: Epidemiology, Infection Control, and Prevention. Infect Dis Clin North Am 2021; 35:1027-1053. [PMID: 34752219 DOI: 10.1016/j.idc.2021.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Invasive fungal infections are an important cause of morbidity and mortality in hospitalized patients and in the immunocompromised population. This article reviews the current epidemiology of nosocomial fungal infections in adult patients, with an emphasis on invasive candidiasis (IC) and invasive aspergillosis (IA). Included are descriptions of nosocomial infections caused by Candida auris, an emerging pathogen, and IC- and IA-associated with coronavirus disease 2019. The characteristics and availability of newer nonculture-based tests for identification of nosocomial fungal pathogens are discussed. Recently published recommendations and guidelines for the control and prevention of these nosocomial fungal infections are summarized.
Collapse
Affiliation(s)
- Geehan Suleyman
- Infection Prevention and Control, Henry Ford Hospital, Wayne State University, 2799 West Grand Boulevard, CFP Suite 317, Detroit, MI 48202, USA
| | - George J Alangaden
- Division of Infectious Diseases, Henry Ford Hospital, Wayne State University, 2799 West Grand Boulevard, CFP Suite 316, Detroit, MI 48202, USA.
| |
Collapse
|
28
|
Invasive Fungal Infections Among Immunocompromised Patients in Critical Care Settings: Infection Prevention Risk Mitigation. Crit Care Nurs Clin North Am 2021; 33:395-405. [PMID: 34742496 DOI: 10.1016/j.cnc.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Most fungal infections are common in humans. Pathogenic fungi are opportunistic but can cause fungal infection disease in patients with immunocompromised conditions, such as malignancy, chemotherapy, transplantation, acquired immunodeficiency syndrome, and usage of immunosuppressant drugs. Most invasive infections are caused by Aspergillus species, mucormycetes, Cryptococcus species, and Candida species. This article focuses on environmental fungi such as Aspergillus species and mucormycetes because the mode of transmission is different. The purpose of this article is to discuss invasive fungal infections (IFIs) caused by environmental fungi and to educate critical care nurses about infection control and risk mitigation to prevent IFIs.
Collapse
|
29
|
Badali H, Shokohi T, Khodavaisy S, Moazeni M, Farhadi M, Nabili M. Molecular typing of clinical and environmental Aspergillus fumigatus isolates from Iran using microsatellites. Curr Med Mycol 2021; 7:25-30. [PMID: 34553094 PMCID: PMC8443879 DOI: 10.18502/cmm.7.1.6180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/17/2020] [Accepted: 12/30/2020] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose Because of the growing incidence of Aspergillus infection, typing methods of Aspergillus species are increasingly being used. Accordingly, studying the spread and population dynamics of strains isolating from clinical and environment, from a single host to large-scale ecosystems is definitely needed. In the current study, we carried out a genetic analysis of nine microsatellite loci in isolates from different regions of Iran to compare and explore the genetic diversity between environmental and clinical A. fumigatus strains. Materials and Methods Sixty-six clinical (n=43) and environmental (n= 23) isolates of A. fumigatus, have collected from six cities of Iran. All A. fumigatus isolates identified based on macroscopic and microscopic characters, the ability to grow at above 45°C, and confirmed using DNA sequencing of the partial b-tubulin gene. Sixty-six A. fumigatus isolates were subjected by microsatellite typing using three separate multiplex PCRs with a panel of nine short tandem repeats (STR) to evaluate the genetic relatedness. Results The STR typing of 66 A. fumigatus isolates revealed 38 distinct genotypes distributed among environmental and clinical isolates. We identified 12 clones including 40 different isolates representing 60% of all isolates tested, which each clone included 2-7 isolates. Conclusion The STR typing is considered as a valuable tool with excellent discriminatory power to study the molecular epidemiology and genotypic diversity of A. fumigatus isolates. These findings show that the high genetic diversity observed of Iranian A. fumigatus isolates with those outside Iran and formed a separate cluster.
Collapse
Affiliation(s)
- Hamid Badali
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Shokohi
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sadegh Khodavaisy
- Department of Medical Mycology and Parasitology, Tehran University of Medical Science, Tehran, Iran
| | - Maryam Moazeni
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoumeh Farhadi
- Department of Medical Laboratory Sciences, Faculty of Medicine, Sari Branch, Islamic Azad University, Sari, Iran
| | - Mojtaba Nabili
- Department of Medical Laboratory Sciences, Faculty of Medicine, Sari Branch, Islamic Azad University, Sari, Iran
| |
Collapse
|
30
|
Sood G, Perl TM. Outbreaks in Health Care Settings. Infect Dis Clin North Am 2021; 35:631-666. [PMID: 34362537 DOI: 10.1016/j.idc.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Outbreaks and pseudo-outbreaks in health care settings are complex and should be evaluated systematically using epidemiologic and molecular tools. Outbreaks result from failures of infection prevention practices, inadequate staffing, and undertrained or overcommitted health care personnel. Contaminated hands, equipment, supplies, water, ventilation systems, and environment may also contribute. Neonatal intensive care, endoscopy, oncology, and transplant units are areas at particular risk. Procedures, such as bronchoscopy and endoscopy, are sources of infection when cleaning and disinfection processes are inadequate. New types of equipment can be introduced and lead to contamination or equipment and medications can be contaminated at the manufacturing source.
Collapse
Affiliation(s)
- Geeta Sood
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Mason F. Lord Building, Center Tower, 3rd Floor, 5200 Eastern Avenue, Baltimore, MD 21224, USA.
| | - Trish M Perl
- Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Y7;302, Dallas, TX 75390, USA
| |
Collapse
|
31
|
Surveillance practices and air-sampling strategies to address healthcare-associated invasive mold infections in Society for Healthcare Epidemiology of America (SHEA) Research Network hospitals-United States, 2020. Infect Control Hosp Epidemiol 2021; 43:1708-1711. [PMID: 34266512 DOI: 10.1017/ice.2021.285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
With this survey, we investigated healthcare-associated invasive mold infection (HA-IMI) surveillance and air sampling practices in US acute-care hospitals. More than half of surveyed facilities performed HA-IMI surveillance and air sampling. HA-IMI surveillance was more commonly performed in academic versus nonacademic facilities. HA-IMI case definitions and sampling strategies varied widely among respondents.
Collapse
|
32
|
Patient notification about suspected hospital-associated outbreaks of invasive mold infections: Considerations for public health and hospital personnel. Infect Control Hosp Epidemiol 2021; 42:871-876. [PMID: 34109919 DOI: 10.1017/ice.2021.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A common type of fungal disease investigation involves hospital-associated clusters of invasive mold infections (IMIs), which typically occur among immunocompromised patients. Responding to IMI clusters can be challenging for public health and hospital personnel for several reasons such as difficulty of confirming the existence of an outbreak, difficulty of determining source. Although many resources exist to guide patient notification about healthcare incidents (eg, bloodborne exposures, disease outbreaks), IMI clusters involve special considerations related to the complex diseases, uncertain exposures, and differential benefits and risks of notification. Early, nuanced communication about hospital-associated IMI clusters is almost always the best course of action to help reduce risks to patients' health and foster trust between patients and hospitals.
Collapse
|
33
|
Nakanishi Y, Kasahara K, Koizumi A, Tokutani J, Yoshihara S, Mikasa K, Imamura T. Evaluation of Nosocomial Infection Control Measures to Minimize the Risk of Aspergillus Dispersion During Major Demolition Work: A Case Study of a Japanese University Hospital. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:58-74. [PMID: 33957793 DOI: 10.1177/19375867211009979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To verify the effectiveness of our infection control measures based on the infection control risk assessment (ICRA) to minimize the risk of Aspergillus dispersion before, during, and after demolition work in a university hospital. BACKGROUND It is widely accepted that invasive aspergillosis is associated with construction, renovation, and demolition activities within or close to hospital sites. However, the risk is underestimated, and only limited preventive measures are taken in Japanese hospitals. METHOD The demolition process, carried out in July 2014, was supervised by our facility management in collaboration with the infection prevention team and followed an adapted ICRA tool. Dust containment measures were implemented to reduce the risk of airborne Aspergillus contamination. Air sampling was performed at four wards in the adjacent hospital buildings to assess the containment measures' effectiveness. RESULTS A high, undetermined number of colonies of bacteria and molds were detected on all outside balconies before demolition. During demolition, Aspergillus spp. was detected only in the ward closest to the demolition site. However, no case of aspergillosis was reported. The difference-in-difference analysis revealed that the interaction between the demolition activity, height of the ward, and distance of the air intake to the demolition activities resulted in a significant increase in the numbers of Aspergillus spp. CONCLUSIONS When large-scale demolition work occurs in hospital premises, Aspergillus spp. may increase in the ward where the vertical and horizontal distance of air intake from the demolition site is close, even though infection control measures based on the ICRA are implemented.
Collapse
Affiliation(s)
- Yasuhiro Nakanishi
- Department of Public Health, Health Management and Policy, 12967Nara Medical University, Japan.,Corporate Administration Department, Research Promotion Division, 12967Nara Medical University, Japan
| | - Kei Kasahara
- Center for Infectious Diseases, 12967Nara Medical University, Japan.,Infection Control Team, 243062Nara Medical University Hospital, Japan
| | - Akira Koizumi
- Infection Control Team, 243062Nara Medical University Hospital, Japan.,Central Clinical Laboratory, 243062Nara Medical University Hospital, Japan
| | - Junko Tokutani
- Infection Control Team, 243062Nara Medical University Hospital, Japan.,Department of Nursing, 243062Nara Medical University Hospital, Japan
| | - Shingo Yoshihara
- Department of Public Health, Health Management and Policy, 12967Nara Medical University, Japan.,Center for Infectious Diseases, 12967Nara Medical University, Japan
| | - Keiichi Mikasa
- Center for Infectious Diseases, 12967Nara Medical University, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, 12967Nara Medical University, Japan
| |
Collapse
|
34
|
Jalili D, Dehghani M, Fadaei A, Alimohammadi M. Assessment of Airborne Bacterial and Fungal Communities in Shahrekord Hospitals. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2021; 2021:8864051. [PMID: 33986812 PMCID: PMC8093067 DOI: 10.1155/2021/8864051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 04/06/2021] [Accepted: 04/19/2021] [Indexed: 01/19/2023]
Abstract
This paper presents information about airborne microorganisms (bacteria and fungi) in the indoor air of two hospitals (Kashani and Hajar) in the city of Shahrekord, Iran. The settle plate technique using open Petri dishes containing different culture media was employed to collect a sample and using Quick Take 30 Sample Pump three days per week for a period of 8 weeks. Standard microbiological methods were employed for the identification of bacterial and fungal isolates. The results showed that the concentration of bacteria in the study area ranged from 0 to 70 cfu/plate/h, while the concentration of fungi was 0 to 280 cfu/plate/h. Also, 12 bacterial and 3 fungal species were isolated and identified with varying frequencies of occurrence, including Staphylococcus spp., Escherichia coli, Salmonella, Enterobacter, Pseudomonas, Serratia Citrobacter, Proteus, and Klebsiella, while the fungal genera isolated included Yeast, Aspergillus flavus, and Penicillium. While the bacterial isolates Staphylococcus aureus (20.50%) and Pseudomonas (9.10%) were the most predominant airborne bacteria, yeast (22.70%) and Penicillium (20.50%) were the most frequently isolated fungal species. The population of microorganisms was the highest during the afternoon. The statistical analysis showed a significant difference between the microbial loads of the two hospitals at P < 0.05. The generated data underline the usefulness of monitoring the air quality of the indoor hospital.
Collapse
Affiliation(s)
- Davood Jalili
- Students' Research Committee, Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - MohamadHadi Dehghani
- Department of Environmental Health Engineering, School of Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolmajid Fadaei
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mahmood Alimohammadi
- Department of Environmental Health Engineering, School of Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
35
|
Matotou HRS, Sangare I, Bisseye C, Akotet MKB, Bamba S. [Biodiversity of isolated fungal flora at the reanimation service of the University Hospital Souro Sanou of Bobo-Dioulasso, Burkina Faso]. Pan Afr Med J 2021; 38:299. [PMID: 34178218 PMCID: PMC8197055 DOI: 10.11604/pamj.2021.38.299.27596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/04/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction les maladies nosocomiales demeurent un problème majeur de santé publique en Afrique subsaharienne notamment au Burkina Faso. Cette étude avait pour but de déterminer la biodiversité de la flore fongique identifiée au service de réanimation du Centre Hospitalier Universitaire Souro Sanou (CHUSS) de Bobo-Dioulasso. Méthodes l´étude transversale descriptive s´est déroulée d´août 2016 à janvier 2017. La flore fongique a été recherchée dans l´air ambiant et les espaces de réanimation. Les prélèvements ont été ensemencés et incubés pendant 3 à 4 jours à 37°C à l´étuve. L´identification des colonies fongiques était macroscopique et microscopique pour les champignons filamenteux. Le test de blastèse, les milieux chromogéniques et le test d´agglutination au latex ont servi à l´identification d´espèces de Candida. Résultats sur les 200 prélèvements collectés au total, 176 ont poussé sur la gélose Sabouraud-Chloramphénicol. La prévalence globale de la flore fongique était de 88% (176/200). Les moisissures étaient les agents fongiques majoritairement retrouvés (66,9%). Parmi les huit genres de moisissures identifiés, Aspergillus était le genre le plus représenté (48,9%) tandis qu´Aspergillus fumigatus était l´espèce la plus fréquemment rencontrée (32,9%). Conclusion la décontamination régulière des niches fongiques devraient être systématiques dans le service de réanimation du CHUSS de Bobo-Dioulasso.
Collapse
Affiliation(s)
- Hadry Roger Sibi Matotou
- Institut Supérieur des Sciences de la Santé, Université Nazi Boni, 01 BP 1091, Bobo-Dioulasso, Burkina Faso.,Université des Sciences de la Santé, Département de Parasitologie-Mycologie, BP 4009 Libreville, Gabon
| | - Ibrahim Sangare
- Institut Supérieur des Sciences de la Santé, Université Nazi Boni, 01 BP 1091, Bobo-Dioulasso, Burkina Faso.,Service de Parasitologie-Mycologie, Département des Laboratoires, Centre Hospitalier Universitaire Souro Sanou, 01 BP 676, Bobo-Dioulasso, Burkina Faso
| | - Cyrille Bisseye
- Laboratoire de Biologie Moléculaire et Cellulaire, Université des Sciences et Techniques de Masuku, BP 943, Franceville, Gabon
| | | | - Sanata Bamba
- Institut Supérieur des Sciences de la Santé, Université Nazi Boni, 01 BP 1091, Bobo-Dioulasso, Burkina Faso.,Service de Parasitologie-Mycologie, Département des Laboratoires, Centre Hospitalier Universitaire Souro Sanou, 01 BP 676, Bobo-Dioulasso, Burkina Faso
| |
Collapse
|
36
|
Dillon CF, Dillon MB. Multi-Scale Airborne Infectious Disease Transmission. Appl Environ Microbiol 2021; 87:AEM.02314-20. [PMID: 33277266 PMCID: PMC7851691 DOI: 10.1128/aem.02314-20] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Airborne disease transmission is central to many scientific disciplines including agriculture, veterinary biosafety, medicine, and public health. Legal and regulatory standards are in place to prevent agricultural, nosocomial, and community airborne disease transmission. However, the overall importance of the airborne pathway is underappreciated, e.g.,, US National Library of Medicine's Medical Subjects Headings (MESH) thesaurus lacks an airborne disease transmission indexing term. This has practical consequences as airborne precautions to control epidemic disease spread may not be taken when airborne transmission is important, but unrecognized. Publishing clearer practical methodological guidelines for surveillance studies and disease outbreak evaluations could help address this situation.To inform future work, this paper highlights selected, well-established airborne transmission events - largely cases replicated in multiple, independently conducted scientific studies. Methodologies include field experiments, modeling, epidemiology studies, disease outbreak investigations and mitigation studies. Collectively, this literature demonstrates that airborne viruses, bacteria, and fungal pathogens have the capability to cause disease in plants, animals, and humans over multiple distances - from near range (< 5 m) to continental (> 500 km) in scale. The plausibility and implications of undetected airborne disease transmission are discussed, including the notable underreporting of disease burden for several airborne transmitted diseases.
Collapse
Affiliation(s)
| | - Michael B Dillon
- Atmospheric, Earth, and Energy Division, Lawrence Livermore National Laboratory Livermore, California, USA 94551
| |
Collapse
|
37
|
Banerjee S, Denning DW, Chakrabarti A. One Health aspects & priority roadmap for fungal diseases : A mini-review. Indian J Med Res 2021; 153:311-319. [PMID: 33906993 PMCID: PMC8204821 DOI: 10.4103/ijmr.ijmr_768_21] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Indexed: 11/29/2022] Open
Abstract
Fungal diseases have not been taken seriously in public health agendas as well as research priorities, despite of globally causing an estimated two million deaths every year, and the emergence of many troublesome fungal pathogens like Candida auris, azole resistant Aspergillus fumigatus, terbinafine and azole resistant dermatophytes, and zoonotic sporotrichosis in humans. Fungi are also responsible for huge losses of agricultural products and stored crops as well as recent massive and unexpected mortality in animals caused by white-nose syndrome in the bats and Chytridiomycosis in amphibians. This review aims to underscore the need for collaborative, multisectoral, and trans-disciplinary approach to include the One Health approach as an essential component of surveillance, prevention, and control of globally emerging fungal diseases. Rigorous evidence based surveillance of the environment as well as strengthening rapid and quality diagnosis of fungal diseases can save millions of lives and reduce significant morbidity.
Collapse
Affiliation(s)
- Sayantan Banerjee
- Department of Infectious Diseases, Beleghata Infectious Diseases & BG Hospitals, Beleghata, Kolkata, West Bengal, India
| | - David W. Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, The University of Manchester, United Kingdom
- Global Action Fund for Fungal Infections, Geneva, Switzerland
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
- Center of Advanced Research in Medical Mycology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
38
|
van der Torre MH, Shen H, Rautemaa-Richardson R, Richardson MD, Novak-Frazer L. Molecular Epidemiology of Aspergillus fumigatus in Chronic Pulmonary Aspergillosis Patients. J Fungi (Basel) 2021; 7:jof7020152. [PMID: 33672698 PMCID: PMC7924367 DOI: 10.3390/jof7020152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 12/17/2022] Open
Abstract
Molecular fungal genotyping techniques developed and employed for epidemiological studies have understandably concentrated on establishing the genetic diversity of Aspergillus fumigatus in invasive aspergillosis due to its severity, the urgency for treatment, and the need to demonstrate possible sources. Some early studies suggested that these strains were phenotypically, if not genotypically, different from others. However, with improved discrimination and evaluations, incorporating environmental as well as clinical isolates from other Aspergillus conditions (e.g., chronic pulmonary aspergillosis and cystic fibrosis), this premise is no longer upheld. Moreover, with the onset of increased global triazole resistance, there has been a concerted effort to incorporate resistance profiling into genotyping studies and the realisation that the wider population of non-immunocompromised aspergillosis patients are at risk. This review summarises the developments in molecular genotyping studies that incorporate resistance profiling with attention to chronic pulmonary aspergillosis and an example of our UK experience.
Collapse
Affiliation(s)
- Mireille H. van der Torre
- Mycology Reference Centre Manchester, ECMM Centre of Excellence in Clinical and Laboratory Mycology and Clinical Studies, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK; (M.H.v.d.T.); (R.R.-R.); (M.D.R.)
- Division of Infection, Inflammation and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
| | - Hongwei Shen
- Division of Infection, Inflammation and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
| | - Riina Rautemaa-Richardson
- Mycology Reference Centre Manchester, ECMM Centre of Excellence in Clinical and Laboratory Mycology and Clinical Studies, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK; (M.H.v.d.T.); (R.R.-R.); (M.D.R.)
- Division of Infection, Inflammation and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
- Department of Infectious Diseases, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK
| | - Malcolm D. Richardson
- Mycology Reference Centre Manchester, ECMM Centre of Excellence in Clinical and Laboratory Mycology and Clinical Studies, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK; (M.H.v.d.T.); (R.R.-R.); (M.D.R.)
- Division of Infection, Inflammation and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
| | - Lilyann Novak-Frazer
- Mycology Reference Centre Manchester, ECMM Centre of Excellence in Clinical and Laboratory Mycology and Clinical Studies, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK; (M.H.v.d.T.); (R.R.-R.); (M.D.R.)
- Division of Infection, Inflammation and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
- Correspondence: ; Tel.: +44-161-2915856
| |
Collapse
|
39
|
Anforderungen an die Infektionsprävention bei der medizinischen Versorgung von immunsupprimierten Patienten. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:232-264. [PMID: 33394069 PMCID: PMC7780910 DOI: 10.1007/s00103-020-03265-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
40
|
Association of Fungal Siderophores in Human Diseases: Roles and Treatments. Fungal Biol 2021. [DOI: 10.1007/978-3-030-53077-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
41
|
Mohamed AH, Balbool BA, Abdel-Azeem AM. Aspergillus from Different Habitats and Their Industrial Applications. Fungal Biol 2021. [DOI: 10.1007/978-3-030-67561-5_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
42
|
Fernández-Cruz A, Semiglia MA, Guinea J, Martínez-Jiménez MDC, Escribano P, Kwon M, Rodríguez-Macías G, Chamorro-de-Vega E, Rodríguez-González C, Navarro R, Galar A, Sánchez-Carrillo C, Díez-Martín JL, Muñoz P. A retrospective cohort of invasive fusariosis in the era of antimould prophylaxis. Med Mycol 2020; 58:300-309. [PMID: 31231772 DOI: 10.1093/mmy/myz060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/06/2019] [Accepted: 05/12/2019] [Indexed: 12/28/2022] Open
Abstract
Mould-active prophylaxis is affecting the epidemiology of invasive mycoses in the form of a shift toward less common entities such as fusariosis. We analyze the characteristics of invasive fusariosis and its association to antifungal prophylaxis in a retrospective cohort (2004-2017) from a tertiary hospital in Madrid, Spain. Epidemiological, clinical, microbiological, and antifungal consumption data were retrieved. Isolates were identified to molecular level, and antifungal susceptibility was tested. Eight cases of invasive fusariosis were diagnosed. Three periods were identified according to incidence: <2008 (three cases), 2008-2013 (zero cases), >2014 (five cases). All except one case involved breakthrough fusariosis. During the earliest period, the episodes occurred while the patient was taking itraconazole (two) or fluconazole (one); more recently, while on micafungin (three) or posaconazole (one). Early cases involved acute leukemia at induction/consolidation, recent cases relapsed/refractory disease (P = .029). Main risk factor for fusariosis (62.5%) was prolonged neutropenia (median 44 days). Galactomannan and beta-D-glucan were positive in 37.5% and 100% of cases, respectively. All isolates except F. proliferatum presented high minimal inhibitory concentrations (MICs) against the azoles and lower MIC to amphotericin B. Most patients received combined therapy. Mortality at 42 days was 62.5%. Resolution of neutropenia was associated with survival (P = .048). Invasive fusariosis occurs as breakthrough infection in patients with hematologic malignancy, prolonged neutropenia, and positive fungal biomarkers. Recent cases were diagnosed in a period of predominant micafungin use in patients who had more advanced disease and protracted neutropenia and for whom mortality was extremely high. Resolution of neutropenia was a favorable prognostic factor.
Collapse
Affiliation(s)
- Ana Fernández-Cruz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - María Auxiliadora Semiglia
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Jesús Guinea
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - María Del Carmen Martínez-Jiménez
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Pilar Escribano
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Mi Kwon
- Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.,Hematology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Gabriela Rodríguez-Macías
- Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.,Hematology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Esther Chamorro-de-Vega
- Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.,Pharmacy Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Carmen Rodríguez-González
- Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.,Pharmacy Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Raquel Navarro
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Alicia Galar
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Carlos Sánchez-Carrillo
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - José Luis Díez-Martín
- Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.,Hematology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
43
|
Performance evaluation of a new mobile air-treatment technology at-rest and under normal work conditions in a conventional hematology room. HEALTH AND TECHNOLOGY 2020. [DOI: 10.1007/s12553-020-00480-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
44
|
Mishra AK, Bansal V, Roy G, Halder V, Gupta P, Chakrabarti A. Aspergillus mediastinitis in a post-operative immunocompetent child. Indian J Med Microbiol 2020; 38:492-495. [PMID: 33154273 DOI: 10.4103/ijmm.ijmm_20_267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Post-operative Aspergillus mediastinitis is regarded to be a devastating infection, usually affecting patients undergoing cardiothoracic surgery with specific predisposing factors characterised by a high mortality and chronic morbidity. Patient outcome after such a complication is extremely poor despite antifungal therapy and surgery. We describe the case of an immunocompetent 2-month-old child with obstructed supracardiac total anomalous pulmonary venous circulation (TAPVC) and severe pulmonary artery hypertension, who underwent TAPVC repair through median sternotomy and developed post-operative mediastinitis due to Aspergillus flavus.
Collapse
Affiliation(s)
- Anand Kumar Mishra
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vidur Bansal
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gradlin Roy
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikram Halder
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parakritii Gupta
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
45
|
Renovation in hospitals: Training construction crews to work in health care facilities. Am J Infect Control 2020; 48:403-409. [PMID: 31676158 DOI: 10.1016/j.ajic.2019.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Health care facilities require frequent renovations to maintain or enhance their service, and to meet the dynamic demands of their patients. Construction activities in active health care facilities are a significant contributor to various challenges that range from infection to death. It is therefore essential to minimize the adverse impacts of construction activities on health care units as well as their adjacent sites. METHODS A questionnaire was developed to study current training modules to prepare construction crews to work in health care environments. The survey was disseminated among professionals of the top 15 health care contractors. A total of 129 individuals participated, and their responses were analyzed using descriptive and categorical statistics. RESULTS This study investigates current training practices regarding (1) the level of training, (2) the frequency of training, and (3) the impact that the sensitivity of the project has on the training. To effectively prepare construction crews, special training must be provided to them. CONCLUSIONS There are uncertainties about the sufficiency and impact of the existing training. Existing trainings are tailored for upper management positions, and the amount/frequency of training for construction crews are substantially low. Findings of this study contribute to characterizing the activities and conditions pertaining to training of construction crews.
Collapse
|
46
|
Viegas C, Almeida B, Monteiro A, Paciência I, Rufo J, Aguiar L, Lage B, Diogo Gonçalves LM, Caetano LA, Carolino E, Gomes AQ, Twarużek M, Kosicki R, Grajewski J, Teixeira JP, Viegas S, Pereira C. Exposure assessment in one central hospital: A multi-approach protocol to achieve an accurate risk characterization. ENVIRONMENTAL RESEARCH 2020; 181:108947. [PMID: 31767353 DOI: 10.1016/j.envres.2019.108947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/15/2019] [Accepted: 11/17/2019] [Indexed: 06/10/2023]
Abstract
The bioburden in a Hospital building originates not only from patients, visitors and staff, but is also disseminated by several indoor hospital characteristics and outdoor environmental sources. This study intends to assess the exposure to bioburden in one central Hospital with a multi-approach protocol using active and passive sampling methods. The microbial contamination was also characterized through molecular tools for toxigenic species, antifungal resistance and mycotoxins and endotoxins profile. Two cytotoxicity assays (MTT and resazurin) were conducted with two cell lines (Calu-3 and THP-1), and in vitro pro-inflammatory potential was assessed in THP-1 cell line. Out of the 15 sampling locations 33.3% did not comply with Portuguese legislation regarding bacterial contamination, whereas concerning fungal contamination 60% presented I/O > 1. Toxigenic fungal species were observed in 27% of the sampled rooms (4 out of 15) and qPCR analysis successfully amplified DNA from the Aspergillus sections Flavi and Fumigati, although mycotoxins were not detected. Growth of distinct fungal species was observed on Sabouraud dextrose agar with triazole drugs, such as Aspergillus section Versicolores on 1 mg/L VORI. The highest concentrations of endotoxins were found in settled dust samples and ranged from 5.72 to 23.0 EU.mg-1. While a considerable cytotoxic effect (cell viability < 30%) was observed in one HVAC filter sample with Calu-3 cell line, it was not observed with THP-1 cell line. In air samples a medium cytotoxic effect (61-68% cell viability) was observed in 3 out of 15 samples. The cytokine responses produced a more potent average cell response (46.8 ± 12.3 ρg/mL IL-1β; 90.8 ± 58.5 ρg/mL TNF-α) on passive samples than air samples (25.5 ± 5.2 ρg/mL IL-1β and of 19.4 ± 5.2 ρg/mL TNF-α). A multi-approach regarding parameters to assess, sampling and analysis methods should be followed to characterize the biorburden in the Hospital indoor environment. This study supports the importance of considering exposure to complex mixtures in indoor environments.
Collapse
Affiliation(s)
- Carla Viegas
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Portugal.
| | - Beatriz Almeida
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal
| | - Ana Monteiro
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal; Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, 1600-560, Lisbon, Portugal
| | - Inês Paciência
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Porto, Portugal
| | - João Rufo
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Lívia Aguiar
- INSA - Instituto Nacional de Saúde Dr. Ricardo Jorge, Departamento de Saúde Ambiental, Porto, Portugal
| | - Bruna Lage
- INSA - Instituto Nacional de Saúde Dr. Ricardo Jorge, Departamento de Saúde Ambiental, Porto, Portugal
| | - Lídia Maria Diogo Gonçalves
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Liliana Aranha Caetano
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal; Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Elisabete Carolino
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal
| | - Anita Quintal Gomes
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal; University of Lisbon Institute of Molecular Medicine, Faculty of Medicine, Lisbon, Portugal
| | - Magdalena Twarużek
- Kazimierz Wielki University, Faculty of Natural Sciences, Institute of Experimental Biology, Department of Physiology and Toxicology, Chodkiewicza 30, 85-064, Bydgoszcz, Poland
| | - Robert Kosicki
- Kazimierz Wielki University, Faculty of Natural Sciences, Institute of Experimental Biology, Department of Physiology and Toxicology, Chodkiewicza 30, 85-064, Bydgoszcz, Poland
| | - Jan Grajewski
- Kazimierz Wielki University, Faculty of Natural Sciences, Institute of Experimental Biology, Department of Physiology and Toxicology, Chodkiewicza 30, 85-064, Bydgoszcz, Poland
| | - João Paulo Teixeira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; INSA - Instituto Nacional de Saúde Dr. Ricardo Jorge, Departamento de Saúde Ambiental, Porto, Portugal
| | - Susana Viegas
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Portugal
| | - Cristiana Pereira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; INSA - Instituto Nacional de Saúde Dr. Ricardo Jorge, Departamento de Saúde Ambiental, Porto, Portugal
| |
Collapse
|
47
|
Otter J, Yezli S, Barbut F, Perl T. An overview of automated room disinfection systems: When to use them and how to choose them. DECONTAMINATION IN HOSPITALS AND HEALTHCARE 2020. [PMCID: PMC7153347 DOI: 10.1016/b978-0-08-102565-9.00015-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Conventional disinfection methods are limited by reliance on the operator to ensure appropriate selection, formulation, distribution, and contact time of the agent. Automated room disinfection (ARD) systems remove or reduce reliance on operators and so they have the potential to improve the efficacy of terminal disinfection. The most commonly used systems are hydrogen peroxide vapor (H2O2 vapor), aerosolized hydrogen peroxide (aHP), and ultraviolet (UV) light. These systems have important differences in their active agent, delivery mechanism, efficacy, process time, and ease of use. The choice of ARD system should be influenced by the intended application, the evidence base for effectiveness, practicalities of implementation, and cost considerations.
Collapse
Affiliation(s)
- J.A. Otter
- NIHR Health Protection Research Unit (HPRU) in HCAIs and AMR at Imperial College London, and Imperial College Healthcare NHS Trust, Infection Prevention and Control, London, United Kingdom
| | - S. Yezli
- Global Centre for Mass Gatherings Medicine, WHO Collaborating Centre for Mass Gatherings Medicine, Ministry of Health-Public Health Directorate, Riyadh, Kingdom of Saudi Arabia
| | - F. Barbut
- National Reference Laboratory for C. difficile, Infection Control Unit, Hôpital Saint Antoine, Paris, France,INSERM S-1139, Faculté de Pharmacie de Paris, Université de Paris, Paris, France
| | - T.M. Perl
- Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| |
Collapse
|
48
|
Tavakoli M, Rivero-Menendez O, Abastabar M, Hedayati MT, Sabino R, Siopi M, Zarrinfar H, Nouripour-Sisakht S, van der Lee H, Valadan R, Meletiadis J, Yazdani Charati J, Seyedmousavi S, Alastruey-Izquierdo A. Genetic diversity and antifungal susceptibility patterns of Aspergillus nidulans complex obtained from clinical and environmental sources. Mycoses 2019; 63:78-88. [PMID: 31609022 DOI: 10.1111/myc.13019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/05/2019] [Accepted: 10/08/2019] [Indexed: 11/27/2022]
Abstract
The molecular epidemiology and antifungal susceptibility of Aspergillus nidulans species complex has not been well studied. To evaluate the genetic diversity and antifungal susceptibility patterns of clinical and environmental isolates of A. nidulans complex. Sixty clinical and environmental isolates of Aspergillus section Nidulantes were collected from five countries (Iran, The Netherlands, Spain, Portugal and Greece). The species were molecularly identified by sequencing of β-tubulin gene. The genetic diversity of A nidulans complex isolates (n = 54) was determined with a microsatellite genotyping assay. Antifungal susceptibility profile was determined using EUCAST method. The isolates were classified as A nidulans (46.7%), A spinulosporus (26.6%), A quadrilineatus (10%), A pachycristatus (3.3%), A rugulosus (3.3%), A unguis (5%), A creber, (1.7%), A olivicola (1.7%) and A sydowii (1.7%). Thirty-four sequence types (STs) were identified among the 54 A nidulans complex isolates. A high level of genetic diversity was found among A nidulans sensu stricto strains but low diversity was found among A spinulosporus strains. Amphotericin B showed high MICs to all species. The most active azole was posaconazole (GM = 0.64 mg/L), while itraconazole showed the highest MICs among azoles (GM = 2.95 mg/L). A spinulosporus showed higher MICs than A nidulans sensu stricto for all antifungals except for micafungin and anidulafungin. Interspecies variations may result in differences in antifungal susceptibility patterns and challenge antifungal therapy in infections caused by A nidulans. Differences in the distribution of STs or persistence of multiple STs might be related to the sources of isolation and niche specialisation.
Collapse
Affiliation(s)
- Mahin Tavakoli
- Student Research Committee, Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Olga Rivero-Menendez
- Medical Mycology Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Mahdi Abastabar
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad T Hedayati
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Raquel Sabino
- Department of Infectious Diseases/Reference Unit for Parasitic and Fungal Infections, Lisbon, Portugal
| | - Maria Siopi
- Clinical Microbiology Laboratory, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Hossein Zarrinfar
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Henrich van der Lee
- Department of Medical Microbiology, Radboud University Medical Center, Center of Expertise Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
| | - Reza Valadan
- Molecular and Cell Biology Research Center (MCBRC), Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Jamshid Yazdani Charati
- Department of Statistic, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyedmojtaba Seyedmousavi
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Center of Expertise in Microbiology, Infection Biology and Antimicrobial Pharmacology, Tehran, Iran.,Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ana Alastruey-Izquierdo
- Medical Mycology Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
49
|
Martony M, Nollens H, Tucker M, Henry L, Schmitt T, Hernandez J. Prevalence of and environmental factors associated with aerosolised Aspergillus spores at a zoological park. Vet Rec Open 2019; 6:e000281. [PMID: 31673372 PMCID: PMC6802980 DOI: 10.1136/vetreco-2018-000281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/02/2018] [Accepted: 08/14/2019] [Indexed: 11/18/2022] Open
Abstract
Aspergillus is a significant pathogen in zoological species, although information on environmental variables influencing fungal prevalence in zoological settings are lacking. The objective of the study was to estimate the prevalence of and to identify environmental factors associated with aerosolised Aspergillus spores at a zoological park to advance the understanding of fungal exposure as a first step towards improved mitigation strategies for susceptible animals. Twenty-one locations were sampled for presence of Aspergillus species using the SAS Super 180 Microbial Air Sampler, while twenty-two environmental factors were evaluated every two weeks at SeaWorld of California during two 12-month periods. In each period, the frequency of investigated environmental factors was compared between samples classified as positive or negative for Aspergillus species using logistic regression. Prevalence of Aspergillus was higher (P<0.05) during the second 12-month period (110/525 or 21 per cent), compared with the first period (62/483 or 13 per cent). In both periods, positive Aspergillus samples were associated with indoor sites without high-efficiency particulate air (HEPA) filtration systems and other infection control measures (adjusted OR=4.33 and 5.19, P<0.01) or outdoor sites (adjusted OR=2.50 and3.79, P≤0.05), compared to indoor sites with HEPA filtration systems and other infection control measures, after controlling for season. Burden of airborne Aspergillus can be higher in indoor sites without HEPA filtration systems than in outdoor sites. The use of HEPA filtration systems and other infection control measures can mitigate the burden of Aspergillus. Risk-based surveillance systems that target indoor areas without HEPA filtration systems can be an efficient approach for early detection of high burden of Aspergillus at zoological parks.
Collapse
Affiliation(s)
- Molly Martony
- College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Hendrik Nollens
- Veterinary Services, SeaWorld San Diego, San Diego, California, USA
| | - Melinda Tucker
- Veterinary Services, SeaWorld San Diego, San Diego, California, USA
| | - Linda Henry
- Veterinary Services, SeaWorld San Diego, San Diego, California, USA
| | - Todd Schmitt
- Veterinary Services, SeaWorld San Diego, San Diego, California, USA
| | - Jorge Hernandez
- College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
50
|
Chen YC, Kuo SF, Wang HC, Wu CJ, Lin YS, Li WS, Lee CH. Azole resistance in Aspergillus species in Southern Taiwan: An epidemiological surveillance study. Mycoses 2019; 62:1174-1181. [PMID: 31549427 DOI: 10.1111/myc.13008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/11/2019] [Accepted: 09/19/2019] [Indexed: 12/01/2022]
Abstract
Poor clinical outcomes for invasive aspergillosis are associated with antifungal resistance. Performing antifungal susceptibility tests on clinically relevant Aspergillus isolates from patients and environmental regions with known azole resistance is recommended. The aim of the study was to assess the presence of azole resistance in clinical Aspergillus spp. isolates and those from hospital environments and farmlands within a 40 km radius of the hospital. Clinical Aspergillus spp. isolates were cultured, as well as environmental Aspergillus spp. isolates obtained from air samples. Samples were subcultured in azole-containing agar plates. Isolates with a positive screening test were subjected to YeastOne methods to determine their minimum inhibitory concentrations of antifungals. Resistance mechanisms were investigated in the azole-resistant Aspergillus spp. isolates. No azole-resistant clinical or environmental A flavus, A oryaze, A niger or A terreus isolates were found in the present study. All A fumigatus clinical isolates were azole-susceptible. Seven A fumigatus environmental isolates were associated with cyp51A mutations, including two that harboured TR34 /L98H mutations with S297T/F495I substitutions, two with TR34 /L98H mutations and three with TR46 /Y121F/T289A mutations. One of these isolates was collected from farmland, one was from A ward and five were from B ward. The proportion of azole-resistant A fumigatus was 10.2% (6/59) and 3.2% (1/31) in the hospital environments and the farmlands near the hospital, respectively. The results showed that azole-resistant A fumigatus existed within hospital environments. This emphasises the importance of periodic surveillance in hospital environments and monitoring for the emergence of azole-resistant A fumigatus clinical isolates.
Collapse
Affiliation(s)
- Yi-Chun Chen
- Department of Internal Medicine, Division of Infectious Diseases, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shu-Fang Kuo
- Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Department of Medical Biotechnology and Laboratory Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsuan-Chen Wang
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Tainan, Taiwan
| | - Chi-Jung Wu
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Tainan, Taiwan.,Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yin-Shiou Lin
- Department of Internal Medicine, Division of Infectious Diseases, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wei-Sin Li
- Department of Internal Medicine, Division of Infectious Diseases, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Department of Internal Medicine, Division of Infectious Diseases, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Kaohsiung, Taiwan
| |
Collapse
|