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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; 12:e0027324. [PMID: 38888358 PMCID: PMC11302659 DOI: 10.1128/spectrum.00273-24] [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: 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.
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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
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Mogensen EH, Holm CK. Intermittent low-dose far-UVC irradiation inhibits growth of common mold below threshold limit value. PLoS One 2024; 19:e0299421. [PMID: 38954713 PMCID: PMC11218994 DOI: 10.1371/journal.pone.0299421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/07/2024] [Indexed: 07/04/2024] Open
Abstract
Mold infestations in buildings pose significant challenges to human health, affecting both private residences and hospitals. While molds commonly trigger asthma and allergies in the immunocompetent, they can cause life-threatening diseases in the immunocompromised. Currently, there is an unmet need for new strategies to reduce or prevent mold infestations. Far-UVC technology can inactivate microorganisms while remaining safe for humans. This study investigates the inhibitory efficacy of far-UVC light at 222 nm on the growth of common mold-producing fungi, specifically Penicillium candidum, when delivered in low-dose on-off duty cycles, a configuration consistent with its use in real-world settings. The inhibitory effect of the low-dose duty cycles was assessed on growth induced by i) an adjacent spore-producing P. candidum donor and ii) P. candidum spores seeded directly onto agar plates. In both setups, the far-UVC light significantly inhibited both vertical and horizontal growth of P. candidum, even when the UV doses were below the Threshold Value Limit of 23 mJ/cm2. These results suggest that far-UVC light holds the potential to improve indoor air quality by reducing or preventing mold growth, also when people are present.
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Neoh CF, Chen SCA, Lanternier F, Tio SY, Halliday CL, Kidd SE, Kong DCM, Meyer W, Hoenigl M, Slavin MA. Scedosporiosis and lomentosporiosis: modern perspectives on these difficult-to-treat rare mold infections. Clin Microbiol Rev 2024; 37:e0000423. [PMID: 38551323 PMCID: PMC11237582 DOI: 10.1128/cmr.00004-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
SUMMARYAlthough Scedosporium species and Lomentospora prolificans are uncommon causes of invasive fungal diseases (IFDs), these infections are associated with high mortality and are costly to treat with a limited armamentarium of antifungal drugs. In light of recent advances, including in the area of new antifungals, the present review provides a timely and updated overview of these IFDs, with a focus on the taxonomy, clinical epidemiology, pathogenesis and host immune response, disease manifestations, diagnosis, antifungal susceptibility, and treatment. An expansion of hosts at risk for these difficult-to-treat infections has emerged over the last two decades given the increased use of, and broader population treated with, immunomodulatory and targeted molecular agents as well as wider adoption of antifungal prophylaxis. Clinical presentations differ not only between genera but also across the different Scedosporium species. L. prolificans is intrinsically resistant to most currently available antifungal agents, and the prognosis of immunocompromised patients with lomentosporiosis is poor. Development of, and improved access to, diagnostic modalities for early detection of these rare mold infections is paramount for timely targeted antifungal therapy and surgery if indicated. New antifungal agents (e.g., olorofim, fosmanogepix) with novel mechanisms of action and less cross-resistance to existing classes, availability of formulations for oral administration, and fewer drug-drug interactions are now in late-stage clinical trials, and soon, could extend options to treat scedosporiosis/lomentosporiosis. Much work remains to increase our understanding of these infections, especially in the pediatric setting. Knowledge gaps for future research are highlighted in the review.
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Affiliation(s)
- Chin Fen Neoh
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Sharon C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia
- The University of Sydney, Sydney, Australia
- Department of Infectious Diseases, Westmead Hospital, Sydney, Australia
| | - Fanny Lanternier
- Service de Maladies Infectieuses et Tropicales, Hôpital universitaire Necker-Enfants malades, Paris, France
- National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology research group, Mycology Department, Institut Pasteur, Université Paris Cité, Paris, France
| | - Shio Yen Tio
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Catriona L Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia
| | - Sarah E Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, Australia
- School of Biological Sciences, Faculty of Sciences, University of Adelaide, Adelaide, Australia
| | - David C M Kong
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- The National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infections and Immunity, Melbourne, Australia
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- School of Medicine, Deakin University, Waurn Ponds, Geelong, Australia
| | - Wieland Meyer
- The University of Sydney, Sydney, Australia
- Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands
| | - Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Translational Medical Mycology Research Group, ECMM Excellence Center for Clinical Mycology, Medical University of Graz, Graz, Austria
| | - Monica A Slavin
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
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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.
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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
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5
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Janssens E, Huygens S, Moors I, Delie A, Kerre T, Vande Weygaerde Y, Van Braeckel E, Boelens J, Morbée L, Schauwvlieghe A. Baseline chest computed tomography for diagnosis of invasive aspergillosis in patients with acute myeloid leukaemia treated with intensive chemotherapy: A retrospective single-centre cohort study. Mycoses 2024; 67:e13715. [PMID: 38477367 DOI: 10.1111/myc.13715] [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: 08/01/2023] [Revised: 12/11/2023] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Invasive pulmonary aspergillosis (IPA) is a relatively common infection in patients with acute myeloid leukaemia (AML), and is associated with high mortality rates. Optimising early detection is key to reduce the burden of IPA in this population. In this retrospective cohort study, we evaluated the added value of baseline chest CT before start of classical induction chemotherapy. METHODS Adult patients receiving first-line intensive chemotherapy for AML were included if a baseline chest CT scan was available (±7 days). Data were collected from the electronic health record. IPA was classified using the EORTC/MSGERC 2020 consensus definitions. RESULTS Between 2015 and 2019, 99 patients were included. During first-line treatment, 29/99 (30%) patients developed a probable IPA. Baseline chest CT was abnormal in 61/99 (62%) and 14/61 (23%) patients had typical radiological signs for IPA. An abnormal scan showed a trend towards higher risk for IPA (hazard ratio (HR): 2.12; 95% CI 0.95-4.84). Ground glass opacities were a strong predictor for developing IPA (HR 3.35: 95% CI 1.61-7.00). No probable/proven IPA was diagnosed at baseline; however, a bronchoalveolar lavage (BAL) at baseline was only performed in seven patients. Twelve-week mortality was higher in patients with IPA (7/26, 27% vs. 5/59, 8%; p = .024). CONCLUSION Baseline chest CT scan could be an asset in the early diagnosis of IPA and contribute to risk estimation for IPA. In patients with an abnormal baseline CT, performing a BAL should be considered more frequently, and not only in patients with radiological findings typical for IPA.
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Affiliation(s)
- Emilie Janssens
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | - Sammy Huygens
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine, Section of Infectious Diseases and Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Ine Moors
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | - Anke Delie
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | - Tessa Kerre
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | | | - Eva Van Braeckel
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Respiratory Infection and Defense lab (RIDL), Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Jerina Boelens
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Alexander Schauwvlieghe
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
- Department of Hematology, AZ Sint-Jan, Bruges, Belgium
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Sarkhoshkalat M, Nasab MA, Yari MR, Tabatabaee SS, Ghavami V, Joulaei F, Sarkhosh M. Assessment of UV radiation effects on airborne mucormycetes and bacterial populations in a hospital environment. Sci Rep 2024; 14:2708. [PMID: 38302627 PMCID: PMC10834397 DOI: 10.1038/s41598-024-53100-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/27/2024] [Indexed: 02/03/2024] Open
Abstract
Infections, such as mucormycosis, often result from inhaling sporangiospore present in the environment. Surprisingly, the extent of airborne Mucormycetes sporangiospore concentrations remains inadequately explored. This study aimed to assess the influence of UV radiation on microbial populations and Mucormycetes spore levels within a hospital environment in northern Iran. A comprehensive dataset comprising 298 air samples collected from both indoor and outdoor settings was compiled. The culture was conducted using Blood Agar and Dichloran Rose Bengal Chloramphenicol (DRBC) culture media, with Chloramphenicol included for fungal agents and Blood Agar for bacterial. Before UV treatment, the average count of Mucormycetes ranged from 0 to 26.4 ± 25.28 CFU m-3, fungal agents from 2.24 ± 3.22 to 117.24 ± 27.6 CFU m-3, and bacterial agents from 29.03 ± 9.9 to 359.37 ± 68.50 CFU m-3. Following UV irradiation, the averages were as follows: Mucormycetes ranged from 0 to 7.85 ± 6.8 CFU m-3, fungal agents from 16.58 ± 4.79 to 154.98 ± 28.35 CFU m-3, and bacterial agents from 0.38 ± 0.65 to 43.92 ± 6.50 CFU m-3. This study, notably marks the pioneering use of UV light to mitigate Mucormycetes spore counts and bacterial agents in northeastern Iran, contributing to the advancement of environmental health and safety practices in hospital settings.
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Affiliation(s)
| | - Mahdi Ahmadi Nasab
- Student Research Committee, Department of Environmental Health Engineering, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Yari
- Student Research Committee, Department of Environmental Health Engineering, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Saeed Tabatabaee
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Vahid Ghavami
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Joulaei
- Department of Environmental Health Engineering, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Sarkhosh
- Department of Environmental Health Engineering, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
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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.
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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
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Speth J. Guidelines in Practice: Design and Maintenance of the Surgical Suite. AORN J 2024; 119:72-80. [PMID: 38149898 DOI: 10.1002/aorn.14054] [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: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 12/28/2023]
Abstract
Hospital construction and renovation is an ongoing occurrence in the health care setting. The recently updated AORN "Guideline for design and maintenance of the surgical suite" provides perioperative nurses with information on the layout design and maintenance of perioperative spaces; safety measures to use during construction and renovation; monitoring and maintenance of the heating, ventilation, and air conditioning; and how to respond to unintended utility failures. This article provides an overview of the guideline and discusses recommendations for the interdisciplinary team, planning and designing the surgical suite, construction-related environmental contamination, ORs, and OR maintenance. It also includes a scenario describing specific concerns associated with the construction of an additional OR. Perioperative nurses should review the guideline in its entirety and apply the recommendations when participating in perioperative construction and renovation projects.
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Redondo González O, Martínez Ramírez NM, Alhama Blanco PJ. Non-touch treatment to solve the persistent contamination of culture plates with Aspergillus niger in a clinical microbiology laboratory of Spain. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:115734-115744. [PMID: 37889415 DOI: 10.1007/s11356-023-30433-8] [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: 06/25/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
A pseudo-outbreak of Aspergillus caused by false positive cultures can have a high sanitary impact. We determined the effectiveness (fungal load elimination) of a non-touch disinfection system, vs conventional disinfection methods, to solve steady contamination of culture plates with Aspergillus niger at a clinical microbiology laboratory. Routine cleaning-disinfection (RCD), intensive cleaning-disinfection (ICD), and terminal airborne disinfection (TAD) were employed in stages. Air sampling was carried out before and after each procedure. The effectiveness of TAD on contact surfaces was tested by surface sampling. After RCD, ICD, and TAD, there was a mean decrease of 5.4 (95% CI = 1.8-9.0), 19.2 (95% CI = 12.4-26.0), and 4.4 (95% CI = 2.5-6.3) CFU per tested area, and 46.2%, 21.7%, and 95.5% of contaminated areas became sterile, respectively. There was a mean decrease of 30.6 CFU per tested surface (p < 0.0007) and 50% of tested surfaces became sterile. Global effectiveness of RCD, ICD, and TAD was 68.8% (95% CI = 68.5-69.1), 82.2% (95% CI = 82.1-82.3), and 99.0% (95% CI = 98.8-99.2), respectively. The effectiveness was higher with TAD (4.1 CFU/cm2 less than with ICD; p = 0.0290). No further contamination has occurred since then. When construction and renovation activities are discarded and RCD and ICD practices are insufficient, non-touch disinfection remove residual dust contamination and avoid recurrence.
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Affiliation(s)
- Olga Redondo González
- Preventive Medicine Service, University Hospital of Guadalajara, C/ Donantes de Sangre S/N, 19002, Guadalajara, Spain.
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid-Barcelona Highway 33,600, 28805, Alcalá de Henares (Madrid), Spain.
| | | | - Pablo J Alhama Blanco
- Electro-Medical Maintenance Service, University Hospital of Guadalajara, C/ Donantes de Sangre S/N, 19002, Guadalajara, Spain
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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.
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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
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11
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Marek A, Meijer EFJ, Tartari E, Zakhour J, Chowdhary A, Voss A, Kanj SS, Bal AM. Environmental monitoring for filamentous fungal pathogens in hematopoietic cell transplant units. Med Mycol 2023; 61:myad103. [PMID: 37793805 DOI: 10.1093/mmy/myad103] [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: 08/07/2023] [Revised: 09/18/2023] [Accepted: 10/03/2023] [Indexed: 10/06/2023] Open
Abstract
The incidence of invasive fungal disease (IFD) is on the rise due to increasing numbers of highly immunocompromized patients. Nosocomial IFD remains common despite our better understanding of its risk factors and pathophysiology. High-efficiency particulate air filtration with or without laminar air flow, frequent air exchanges, a positive pressure care environment, and environmental hygiene, amongst other measures, have been shown to reduce the mould burden in the patient environment. Environmental monitoring for moulds in areas where high-risk patients are cared for, such as hematopoietic cell transplant units, has been considered an adjunct to other routine environmental precautions. As a collaborative effort between authors affiliated to the Infection Prevention and Control Working Group and the Fungal Infection Working Group of the International Society of Antimicrobial Chemotherapy (ISAC), we reviewed the English language literature and international guidance to describe the evidence behind the need for environmental monitoring for filamentous fungi as a quality assurance approach with an emphasis on required additional precautions during periods of construction. Many different clinical sampling approaches have been described for air, water, and surface sampling with significant variation in laboratory methodologies between reports. Importantly, there are no agreed-upon thresholds that correlate with an increase in the clinical risk of mould infections. We highlight important areas for future research to assure a safe environment for highly immunocompromized patients.
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Affiliation(s)
- Aleksandra Marek
- Department of Microbiology, Glasgow Royal Infirmary, Glasgow, UK
- Infection Control Working Group, International Society of Antimicrobial Chemotherapy
| | - Eelco F J Meijer
- Canisius-Wilhelmina Hospital (CWZ), Medical Microbiology and Infectious Diseases, Nijmegen, The Netherlands
- Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, The Netherlands
- Fungal Infection Working Group, International Society of Antimicrobial Chemotherapy
| | - Ermira Tartari
- Faculty of Health Sciences, University of Malta, Msida, Malta
- Infection Control Working Group, International Society of Antimicrobial Chemotherapy
| | - Johnny Zakhour
- Division of Infectious Diseases, Department of Internal Medicine and Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anuradha Chowdhary
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
- National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
- Fungal Infection Working Group, International Society of Antimicrobial Chemotherapy
| | - Andreas Voss
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands
- Infection Control Working Group, International Society of Antimicrobial Chemotherapy
| | - Souha S Kanj
- Division of Infectious Diseases, Department of Internal Medicine and Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
- Fungal Infection Working Group, International Society of Antimicrobial Chemotherapy
| | - Abhijit M Bal
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK
- Fungal Infection Working Group, International Society of Antimicrobial Chemotherapy
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12
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Abd El-Baky RM, Shady ER, Yahia R, Ahmed FY, Ramadan M, Ahmed HR, Al-Kadmy IMS, Ramadan YN, Hetta HF. COVID-19 associated Mucormycosis among ICU patients: risk factors, control, and challenges. AMB Express 2023; 13:99. [PMID: 37736777 PMCID: PMC10516834 DOI: 10.1186/s13568-023-01599-8] [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: 06/29/2023] [Accepted: 08/24/2023] [Indexed: 09/23/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic is still difficult to be controlled. The spread of this virus and the emergence of new variants are considered a great challenge worldwide. Disturbance in infection control guidelines implementation, use of steroids, antibiotics, hospital crowdedness, and repeated use of oxygen masks during the management of critically ill COVID-19 patients lead to an increase in the rate of opportunistic infections. So, patients need to fight both the virus with its different variants and opportunistic pathogens including bacteria and fungi especially patients with diabetes mellitus, malignancy, or those who undergo hemodialysis and receive deferoxamine. During the pandemic, many cases of Mucormycosis associated with COVID-19 infection were observed in many countries. In this review, we discuss risk factors that increase the chance of infection by opportunistic pathogens, especially fungal pathogens, recent challenges, and control measures.
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Affiliation(s)
- Rehab Mahmoud Abd El-Baky
- Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia, 61519, Egypt.
- Department of Microbiology and Immunology, Faculty of Pharmacy, Deraya University, Minia, 11566, Egypt.
| | - Esraa R Shady
- Department of Microbiology and Immunology, Faculty of Pharmacy, Deraya University, Minia, 11566, Egypt
| | - Ramadan Yahia
- Department of Microbiology and Immunology, Faculty of Pharmacy, Deraya University, Minia, 11566, Egypt
| | - Fatma Y Ahmed
- Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia, 61519, Egypt
| | - Mohamed Ramadan
- Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia, 61519, Egypt
| | - Hala Rady Ahmed
- Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia, 61519, Egypt
| | - Israa M S Al-Kadmy
- Branch of Biotechnology, Department of Biology, College of Science, Mustansiriyah University, POX 10244, Baghdad, Iraq
| | - Yasmin N Ramadan
- Department of Microbiology and Immunology, Faculty of Pharmacy, Assiut University, Assiut, 71515, Egypt.
| | - Helal F Hetta
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
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13
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Apisarnthanarak A, Ling ML, Weber DJ. The role of environmental and healthcare-associated infections in Asia: Lessons learned from the coronavirus disease 2019 (COVID-19) pandemic. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e100. [PMID: 37396196 PMCID: PMC10311687 DOI: 10.1017/ash.2023.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Anucha Apisarnthanarak
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Moi Lin Ling
- Infection Prevention & Epidemiology, Singapore General Hospital, Outram Road, Singapore, Singapore
| | - David J. Weber
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
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14
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Pham D, Howard-Jones AR, Sparks R, Stefani M, Sivalingam V, Halliday CL, Beardsley J, Chen SCA. Epidemiology, Modern Diagnostics, and the Management of Mucorales Infections. J Fungi (Basel) 2023; 9:659. [PMID: 37367595 DOI: 10.3390/jof9060659] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023] Open
Abstract
Mucormycosis is an uncommon, yet deadly invasive fungal infection caused by the Mucorales moulds. These pathogens are a WHO-assigned high-priority pathogen group, as mucormycosis incidence is increasing, and there is unacceptably high mortality with current antifungal therapies. Current diagnostic methods have inadequate sensitivity and specificity and may have issues with accessibility or turnaround time. Patients with diabetes mellitus and immune compromise are predisposed to infection with these environmental fungi, but COVID-19 has established itself as a new risk factor. Mucorales also cause healthcare-associated outbreaks, and clusters associated with natural disasters have also been identified. Robust epidemiological surveillance into burden of disease, at-risk populations, and emerging pathogens is required. Emerging serological and molecular techniques may offer a faster route to diagnosis, while newly developed antifungal agents show promise in preliminary studies. Equitable access to these emerging diagnostic techniques and antifungal therapies will be key in identifying and treating mucormycosis, as delayed initiation of therapy is associated with higher mortality.
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Affiliation(s)
- David Pham
- Centre for Infectious Diseases & Microbiology, Westmead Hospital, Westmead, NSW 2170, Australia
| | - Annaleise R Howard-Jones
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
- Faculty of Medicine & Health, University of Sydney, Camperdown, NSW 2006, Australia
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW 2006, Australia
| | - Rebecca Sparks
- Douglass Hanly Moir Pathology, Sydney, NSW 2113, Australia
| | - Maurizio Stefani
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
| | - Varsha Sivalingam
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
| | - Catriona L Halliday
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
| | - Justin Beardsley
- Centre for Infectious Diseases & Microbiology, Westmead Hospital, Westmead, NSW 2170, Australia
- Faculty of Medicine & Health, University of Sydney, Camperdown, NSW 2006, Australia
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW 2006, Australia
- Westmead Institute for Medical Research, Sydney, NSW 2145, Australia
| | - Sharon C-A Chen
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
- Faculty of Medicine & Health, University of Sydney, Camperdown, NSW 2006, Australia
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW 2006, Australia
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15
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Roman-Montes CM, Bojorges-Aguilar S, Corral-Herrera EA, Rangel-Cordero A, Díaz-Lomelí P, Cervantes-Sanchez A, Martinez-Guerra BA, Rajme-López S, Tamez-Torres KM, Martínez-Gamboa RA, González-Lara MF, Ponce-de-Leon A, Sifuentes-Osornio J. Fungal Infections in the ICU during the COVID-19 Pandemic in Mexico. J Fungi (Basel) 2023; 9:jof9050583. [PMID: 37233294 DOI: 10.3390/jof9050583] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
Background: Invasive Fungal Infections (IFI) are emergent complications of COVID-19. In this study, we aim to describe the prevalence, related factors, and outcomes of IFI in critical COVID-19 patients. Methods: We conducted a nested case-control study of all COVID-19 patients in the intensive care unit (ICU) who developed any IFI and matched age and sex controls for comparison (1:1) to evaluate IFI-related factors. Descriptive and comparative analyses were made, and the risk factors for IFI were compared versus controls. Results: We found an overall IFI prevalence of 9.3% in COVID-19 patients in the ICU, 5.6% in COVID-19-associated pulmonary aspergillosis (CAPA), and 2.5% in invasive candidiasis (IC). IFI patients had higher SOFA scores, increased frequency of vasopressor use, myocardial injury, and more empirical antibiotic use. CAPA was classified as possible in 68% and 32% as probable by ECMM/ISHAM consensus criteria, and 57.5% of mortality was found. Candidemia was more frequent for C. parapsilosis Fluconazole resistant outbreak early in the pandemic, with a mortality of 28%. Factors related to IFI in multivariable analysis were SOFA score > 2 (aOR 5.1, 95% CI 1.5-16.8, p = 0.007) and empiric antibiotics for COVID-19 (aOR 30, 95% CI 10.2-87.6, p = <0.01). Conclusions: We found a 9.3% prevalence of IFIs in critically ill patients with COVID-19 in a single center in Mexico; factors related to IFI were associated with higher SOFA scores and empiric antibiotic use for COVID-19. CAPA is the most frequent type of IFI. We did not find a mortality difference.
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Affiliation(s)
- Carla M Roman-Montes
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Saul Bojorges-Aguilar
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Ever Arturo Corral-Herrera
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Andrea Rangel-Cordero
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Paulette Díaz-Lomelí
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Axel Cervantes-Sanchez
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Bernardo A Martinez-Guerra
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Sandra Rajme-López
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Karla María Tamez-Torres
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Rosa Areli Martínez-Gamboa
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Maria Fernanda González-Lara
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Alfredo Ponce-de-Leon
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - José Sifuentes-Osornio
- General Direction, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
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16
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Ogawa Y, Murata K, Hasegawa K, Nishida K, Gohma I, Kasahara K. Clinical characteristics of patients with coronavirus disease 2019-associated pulmonary aspergillosis on mechanical ventilation: A single-center retrospective study in Japan. J Infect Chemother 2023; 29:239-243. [PMID: 36379404 PMCID: PMC9657892 DOI: 10.1016/j.jiac.2022.11.001] [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: 07/30/2022] [Revised: 10/10/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Aspergillus is one of the important pathogens that contribute to high mortality in patients with coronavirus disease 2019 (COVID-19) in intensive care units (ICUs). Although incidence rates of Aspergillus coinfection are high globally, a Japanese national survey reported a low incidence. This study aimed to describe the clinical characteristics of patients with COVID-19-associated pulmonary aspergillosis at our institute. METHODS We identified patients with microbiologically confirmed COVID-19 on mechanical ventilation in the ICU. Of these patients, we identified patients in whom Aspergillus was cultured from the respiratory specimen. RESULTS Of a total of 169 patients, seven had aspergillosis (4.1%), which included three patients, three patients, and one patient with possible, probable, and proven aspergillosis, respectively, according to the criteria of the European Confederation of Medical Mycology International Society. All patients received systemic steroid therapy. Two patients (one each with proven and probable aspergillosis) had tracheobronchitis diagnosed by bronchoscopy. All patients in whom Aspergillus was repeatedly isolated from samples died. The mortality rates for all cases and probable and proven cases were 57% (4/7) and 75% (3/4), respectively. CONCLUSIONS The incidence rate of aspergillosis in patients with COVID-19 in the ICU was higher in our institute than that reported by a Japanese national survey (4.1% vs. 0.5%). Repeated detection of Aspergillus might suggest a true Aspergillus infection, such as chronic aspergillosis, rather than colonization. In patients with severe COVID-19 patients, it is important to always keep CAPA in mind.
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Affiliation(s)
- Yoshihiko Ogawa
- Department of Infectious Diseases, Sakai City Medical Center, Sakai, Osaka, Japan.
| | - Kenya Murata
- Department of Infectious Diseases, Sakai City Medical Center, Sakai, Osaka, Japan
| | - Kohei Hasegawa
- Department of Infectious Diseases, Sakai City Medical Center, Sakai, Osaka, Japan
| | - Koji Nishida
- Department of Respiratory Medicine, Sakai City Medical Center, Sakai, Osaka, Japan
| | - Iwao Gohma
- Department of Respiratory Medicine, Sakai City Medical Center, Sakai, Osaka, Japan
| | - Kei Kasahara
- Center for Infectious Diseases, Nara Medical University, Nara, Japan
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17
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Samaddar A, Shrimali T, Sharma A. Mucormycosis caused by Apophysomyces species: An experience from a tertiary care hospital in Western India and systematic review of global cases. Mycoses 2023; 66:181-195. [PMID: 36227645 DOI: 10.1111/myc.13538] [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: 08/18/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 02/04/2023]
Abstract
Apophysomyces species are an emerging cause of mucormycosis in several regions of the world, primarily affecting immunocompetent individuals. The present study addresses the global epidemiology, clinical presentation, management and outcome of mucormycosis caused by Apophysomyces spp. The study included patients diagnosed with Apophysomyces infection at our hospital between March 2019 and August 2020. In addition, cases published in PubMed and Google Scholar from inception to July 2022 were systematically searched and analysed. Only proven and probable cases that meet the eligibility criteria were included. The Indian cases were compared with those from other countries, and the results were analysed by descriptive statistics. In total, six cases of mucormycosis due to Apophysomyces spp. were diagnosed at our hospital, with additional 250 cases identified through literature search. The main underlying diseases were diabetes mellitus (24%), malignancy (3.2%) and chronic kidney disease (2.8%). The major predisposing factor was trauma (55.6%). Necrotizing fasciitis was the most common (63.2%) clinical presentation. Healthcare-associated mucormycosis accounted for 10.4% of the cases. Globally, A. elegans was the most common species (48.8%), whereas A. variabilis was predominant (86.2%) in India. Surgery was performed in 83.5% of patients. Among those treated with antifungal agents, 98% received amphotericin B and 8.1% received posaconazole. Inappropriate antifungal usage was observed in 12.7%. The overall mortality was 42.3%. A combined medical and surgical management was associated with higher survival. Our study highlights the knowledge gap among physicians regarding this infection. A timely diagnosis and aggressive management can improve the outcomes in such cases.
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Affiliation(s)
- Arghadip Samaddar
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Twishi Shrimali
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Anuradha Sharma
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India.,Department of Microbiology, All India Institute of Medical Sciences, Bilaspur, India
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18
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Hasegawa K, Doi A, Kuroda H, Hasuike T, Ogura A, Nasu S, Nishioka H, Tomii K. A pseudo-outbreak of COVID-19 associated pulmonary aspergillosis: a microbiological investigation of both the patients and the environment. J Infect Prev 2023; 24:83-88. [PMID: 36811012 PMCID: PMC9843133 DOI: 10.1177/17571774231152721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023] Open
Abstract
Background We experienced a pseudo-outbreak of aspergillosis in a newly constructed COVID-19 ward. Within the first 3 months from the commencement of the ward, six intubated patients of COVID-19 developed probable or possible pulmonary aspergillosis. We suspected an outbreak of pulmonary aspergillosis associated with ward construction and launched air sampling for the investigation of the relationship between these. Methods The samples were collected at 13 locations in the prefabricated ward and three in the general wards, not under construction, as a control. Results The results from samples revealed different species of Aspergillus from those detected by the patients. Aspergillus sp. was detected not only from the air samples in the prefabricated ward but also in the general ward. Discussion In this investigation, we could not find evidence of the outbreak that links the construction of the prefabricated ward with the occurrence of pulmonary aspergillosis. It might suggest that this series of aspergillosis was more likely occurred from fungi that inherently colonized patients, and was associated with patient factors such as severe COVID-19 rather than environmental factors. Once an outbreak originating from building construction is suspected, it is important to conduct an environmental investigation including an air sampling.
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Affiliation(s)
- Kohei Hasegawa
- Infectious Diseases, Kobe City Medical Center General Hospital, Japan,Infection Control and Prevention, Kobe City Medical Center General Hospital, Japan
| | - Asako Doi
- Infectious Diseases, Kobe City Medical Center General Hospital, Japan,Infection Control and Prevention, Kobe City Medical Center General Hospital, Japan
| | - Hirokazu Kuroda
- Infectious Diseases, Kobe City Medical Center General Hospital, Japan,Infection Control and Prevention, Kobe City Medical Center General Hospital, Japan
| | - Toshikazu Hasuike
- Infectious Diseases, Kobe City Medical Center General Hospital, Japan,Infection Control and Prevention, Kobe City Medical Center General Hospital, Japan
| | - Akiko Ogura
- Infectious Diseases, Kobe City Medical Center General Hospital, Japan,Infection Control and Prevention, Kobe City Medical Center General Hospital, Japan,Nursing, Kobe City Medical Center General Hospital, Japan
| | - Seiko Nasu
- Infection Control and Prevention, Kobe City Medical Center General Hospital, Japan,Clinical Laboratory, Kobe City Medical Center General Hospital, Japan
| | - Hiroaki Nishioka
- Infectious Diseases, Kobe City Medical Center General Hospital, Japan,General Internal Medicine, Kobe City Medical Center General Hospital, Japan
| | - Keisuke Tomii
- Respiratory Medicine, Kobe City Medical Center General Hospital, Japan
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19
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Ventilator-Associated Pneumonia in Immunosuppressed Patients. Antibiotics (Basel) 2023; 12:antibiotics12020413. [PMID: 36830323 PMCID: PMC9952186 DOI: 10.3390/antibiotics12020413] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Immunocompromised patients-including patients with cancer, hematological malignancies, solid organ transplants and individuals receiving immunosuppressive therapies for autoimmune diseases-account for an increasing proportion of critically-ill patients. While their prognosis has improved markedly in the last decades, they remain at increased risk of healthcare- and intensive care unit (ICU)-acquired infections. The most frequent of these are ventilator-associated lower respiratory tract infections (VA-LTRI), which include ventilator-associated pneumonia (VAP) and tracheobronchitis (VAT). Recent studies have shed light on some of the specific features of VAP and VAT in immunocompromised patients, which is the subject of this narrative review. Contrary to previous belief, the incidence of VAP and VAT might actually be lower in immunocompromised than non-immunocompromised patients. Further, the relationship between immunosuppression and the incidence of VAP and VAT related to multidrug-resistant (MDR) bacteria has also been challenged recently. Etiological diagnosis is essential to select the most appropriate treatment, and the role of invasive sampling, specifically bronchoscopy with bronchoalveolar lavage, as well as new molecular syndromic diagnostic tools will be discussed. While bacteria-especially gram negative bacteria-are the most commonly isolated pathogens in VAP and VAT, several opportunistic pathogens are a special concern among immunocompromised patients, and must be included in the diagnostic workup. Finally, the impact of immunosuppression on VAP and VAT outcomes will be examined in view of recent papers using improved statistical methodologies and treatment options-more specifically empirical antibiotic regimens-will be discussed in light of recent findings on the epidemiology of MDR bacteria in this population.
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Assessing compliance of infection prevention mitigation strategies in hospital construction and renovation. Infect Control Hosp Epidemiol 2023; 44:342-344. [PMID: 36786645 DOI: 10.1017/ice.2021.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hospital-associated fungal infections from construction and renovation activities can be mitigated using an infection control risk assessment (ICRA) and implementation of infection prevention measures. The effectiveness of these measures depends on proper installation and maintenance. Consistent infection prevention construction rounding with feedback is key to ongoing compliance.
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21
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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.
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22
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Fan X, Dai RC, Kudinha T, Gu L. A pseudo-outbreak of Cyberlindnera fabianii funguria: Implication from whole genome sequencing assay. Front Cell Infect Microbiol 2023; 13:1130645. [PMID: 36960046 PMCID: PMC10030058 DOI: 10.3389/fcimb.2023.1130645] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/21/2023] [Indexed: 03/09/2023] Open
Abstract
Background Although the yeast Cyberlindnera fabianii (C. fabianii) has been rarely reported in human infections, nosocomial outbreaks caused by this organism have been documented. Here we report a pseudo-outbreak of C. fabianii in a urology department of a Chinese hospital over a two-week period. Methods Three patients were admitted to the urology department of a tertiary teaching hospital in Beijing, China, from Nov to Dec 2018, for different medical intervention demands. During the period Nov 28 to Dec 5, funguria occurred in these three patients, and two of them had positive urine cultures multiple times. Sequencing of rDNA internal transcribed spacer (ITS) region and MALDI-TOF MS were applied for strain identification. Further, sequencing of rDNA non-transcribed spacer (NTS) region and whole genome sequencing approaches were used for outbreak investigation purpose. Results All the cultured yeast strains were identified as C. fabianii by sequencing of ITS region, and were 100% identical to the C. fabianii type strain CBS 5640T. However, the MALDI-TOF MS system failed to correctly identify this yeast pathogen. Moreover, isolates from these three clustered cases shared 99.91%-100% identical NTS region sequences, which could not rule out the possibility of an outbreak. However, whole genome sequencing results revealed that only two of the C. fabianii cases were genetically-related with a pairwise SNP of 192 nt, whilst the third case had over 26,000 SNPs on its genome, suggesting a different origin. Furthermore, the genomes of the first three case strains were phylogenetically even more diverged when compared to a C. fabianii strain identified from another patient, who was admitted to a general surgical department of the same hospital 7 months later. One of the first three patients eventually passed away due to poor general conditions, one was asymptomatic, and other clinically improved. Conclusion In conclusion, nosocomial outbreaks caused by emerging and uncommon fungal species are increasingly being reported, hence awareness must be raised. Genotyping with commonly used universal gene targets may have limited discriminatory power in tracing the sources of infection for these organisms, requiring use of whole genome sequencing to confirm outbreak events.
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Affiliation(s)
- Xin Fan
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Rong-Chen Dai
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Timothy Kudinha
- School of Dentistry and Medical Sciences, Charles Sturt University, Leeds Parade, Oranges, NSW, Australia
- NSW Health Pathology, Regional and Rural, Orange hospital, Orange, NSW, Australia
| | - Li Gu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Li Gu,
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23
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Karaman S, Kebudi R, Kizilocak H, Karakas Z, Demirag B, Evim MS, Yarali N, Kaya Z, Karagun BS, Aydogdu S, Caliskan U, Ayhan AC, Bahadir A, Cakir B, Guner BT, Albayrak C, Karapinar DY, Kazanci EG, Unal E, Turkkan E, Akici F, Bor O, Vural S, Yilmaz S, Apak H, Baytan B, Tahta NM, Güzelkucuk Z, Kocak U, Antmen B, Tokgöz H, Fisgin T, Özdemir N, Gunes AM, Vergin C, Unuvar A, Ozbek N, Tugcu D, Bay SB, Tanyildiz HG, Celkan T. Central Nervous System Fungal Infections in Children With Leukemia and Undergoing Hematopoietic Stem Cell Transplantation: A Retrospective Multicenter Study. J Pediatr Hematol Oncol 2022; 44:e1039-e1045. [PMID: 36036521 DOI: 10.1097/mph.0000000000002499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Central nervous system fungal infections (CNSFI) are seen in patients with hematologic malignancies and have high morbidity and mortality. Because of their rarity, there is limited data on CNSFI in children with no established treatment protocols or guidelines. MATERIALS AND METHODS In this multicenter retrospective study, 51 pediatric patients with leukemia, 6 of whom had undergone bone marrow transplantation, with proven or probable CNSFI were evaluated. Fungal infections were defined as proven or probable based on European Organisation for Research and Treatment of Cancer criteria. Proven CNSFI was diagnosed by appropriate central nervous system (CNS) imaging or tissue sample findings in combination with positive microbiological results of cerebrospinal fluid. A positive culture, microscopic evidence of hyphae, a positive result of the galactomannan assays are defined as positive microbiological evidence. Probable CNSFI was defined as appropriate CNS imaging findings together with proven or probable invasive fungal infections at another focus without CNS when there is no other explanatory condition. Data was collected by using the questionnaire form (Supplemental Digital Content 1, http://links.lww.com/JPHO/A541 ). RESULTS Seventeen patients had proven, 34 patients had probable CNSFI. Headaches and seizures were the most common clinical findings. The median time between the onset of fever and diagnosis was 5 days. The most common fungal agent identified was Aspergillus . Sixteen patients received single-agent, 35 received combination antifungal therapy. Surgery was performed in 23 patients. Twenty-two patients (43%) died, 29 of the CNSFI episodes recovered with a 20% neurological sequelae. CONCLUSION CNSFIs should be considered in the differential diagnosis in patients with leukemia and refractory/recurrent fever, headache, neurologicalocular symptoms, and a radiologic-serological evaluation should be performed immediately. Early diagnosis and prompt management, both medical and surgical, are essential for improving clinical outcomes.
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Affiliation(s)
- Serap Karaman
- Division of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine, Istanbul University
| | - Rejin Kebudi
- Division of Pediatric Hematology-Oncology, Istanbul University Oncology Institute
| | - Hande Kizilocak
- Division of Pediatric Hematology-Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa
| | - Zeynep Karakas
- Division of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine, Istanbul University
| | - Bengu Demirag
- Division of Pediatric Hematology-Oncology, University of Health Sciences Dr. Behcet Uz Children's Hospital
| | - Melike S Evim
- Division of Pediatric Hematology-Oncology, Faculty of Medicine, Uludağ University
| | - Nese Yarali
- Division of Pediatric Hematology-Oncology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital
| | - Zuhre Kaya
- Division of Pediatric Hematology-Oncology, Faculty of Medicine, Gazi University, Ankara
| | - Barbaros S Karagun
- Division of Pediatric Hematology-Oncology, Acibadem Adana Hospital, Adana
| | - Selime Aydogdu
- Division of Pediatric Hematology-Oncology, Altinbas University Bahcelievler Medical Park Hospital
| | - Umran Caliskan
- Division of Pediatric Hematology-Oncology, Meram University Faculty of Medicine, Konya
| | - Aylin C Ayhan
- Division of Pediatric Hematology-Oncology, Medeniyet University, Faculty of Medicine
| | - Aysenur Bahadir
- Division of Pediatric Hematology-Oncology, Karadeniz Technical University, Faculty of Medicine, Trabzon
| | - Betul Cakir
- Division of Pediatric Hematology-Oncology, Bezmiâlem Vakif University
| | - Burcak T Guner
- Division of Pediatric Hematology-Oncology, Izmir University of Health Sciences Tepecik Training and Research Hospital
| | - Canan Albayrak
- Division of Pediatric Hematology-Oncology, Ondokuz Mayis University, Faculty of Medicine, Samsun
| | - Deniz Y Karapinar
- Division of Pediatric Hematology-Oncology, Faculty of Medicine, Ege University
| | - Elif G Kazanci
- Division of Pediatric Hematology-Oncology, Health Sciences University Bursa High Specialist Training and Research Hospital, Bursa
| | - Ekrem Unal
- Division of Pediatric Hematology-Oncology, Erciyes University Faculty of Medicine, Kayseri
| | - Emine Turkkan
- Division of Pediatric Hematology-Oncology, University of Health Sciences, Okmeydani Training and Research Hospital
| | - Ferhan Akici
- Division of Pediatric Hematology-Oncology, University of Health Science Kanuni Sultan Süleyman Research and Training Hospital
| | - Ozcan Bor
- Division of Pediatric Hematology-Oncology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Sema Vural
- Division of Pediatric Hematology-Oncology, Health Sciences University Istanbul Sariyer Hamidiye Etfal Health Practice and Research Center, Istanbul
| | - Sebnem Yilmaz
- Division of Pediatric Hematology-Oncology, Dokuz Eylul University Faculty of Medicine, Izmir
| | - Hilmi Apak
- Division of Pediatric Hematology-Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa
| | - Birol Baytan
- Division of Pediatric Hematology-Oncology, Faculty of Medicine, Uludağ University
| | - Neryal M Tahta
- Division of Pediatric Hematology-Oncology, University of Health Sciences Dr. Behcet Uz Children's Hospital
| | - Zeliha Güzelkucuk
- Division of Pediatric Hematology-Oncology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital
| | - Ulker Kocak
- Division of Pediatric Hematology-Oncology, Faculty of Medicine, Gazi University, Ankara
| | - Bulent Antmen
- Division of Pediatric Hematology-Oncology, Acibadem Adana Hospital, Adana
| | - Huseyin Tokgöz
- Division of Pediatric Hematology-Oncology, Meram University Faculty of Medicine, Konya
| | - Tunc Fisgin
- Division of Pediatric Hematology-Oncology, Altinbas University Bahcelievler Medical Park Hospital
| | - Nihal Özdemir
- Division of Pediatric Hematology-Oncology, University of Health Science Kanuni Sultan Süleyman Research and Training Hospital
| | - Adalet M Gunes
- Division of Pediatric Hematology-Oncology, Faculty of Medicine, Uludağ University
| | - Canan Vergin
- Division of Pediatric Hematology-Oncology, University of Health Sciences Dr. Behcet Uz Children's Hospital
| | - Aysegul Unuvar
- Division of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine, Istanbul University
| | - Namik Ozbek
- Division of Pediatric Hematology-Oncology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital
| | - Deniz Tugcu
- Division of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine, Istanbul University
| | - Sema B Bay
- Division of Pediatric Hematology-Oncology, Istanbul University Oncology Institute
| | - Hikmet G Tanyildiz
- Division of Pediatric Hematology-Oncology, Istanbul Faculty of Medicine, Istanbul University
| | - Tiraje Celkan
- Division of Pediatric Hematology-Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa
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Dailly S, Boatswain E, Brooks J, Campbell G, Dallow K, Dushianthan A, Glover S, Griffiths M, Gupta S, Austin J, Chambers R, Jeremiah S, Morris C, Mahobia N, Poxon M, Rickman A, Jaques H, Yam T, Saeed K. Aspergillus in COVID-19 intensive care unit; what is lurking above your head? J Infect Prev 2022; 23:278-284. [PMID: 36277859 PMCID: PMC9475376 DOI: 10.1177/17571774221127548] [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: 12/23/2022] [Accepted: 09/04/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Through routine respiratory samples surveillance among COVID-19 patients in
the intensive care, three patients with aspergillus were identified in a
newly opened general intensive care unit during the second wave of the
pandemic. Methodology As no previous cases of aspergillus had occurred since the unit had opened.
An urgent multidisciplinary outbreak meeting was held. The possible sources
of aspergillus infection were explored. The multidisciplinary approach
enabled stakeholders from different skills to discuss possible sources and
management strategies. Environmental precipitants like air handling units
were considered and the overall clinical practice was reviewed. Settle
plates were placed around the unit to identify the source. Reports of recent
water leaks were also investigated. Results Growth of aspergillus on a settle plate was identified the potential source
above a nurse’s station. This was the site of a historic water leak from the
ceiling above, that resolved promptly and was not investigated further.
Subsequent investigation above the ceiling tiles found pooling of water and
mould due to a slow water leak from a pipe. Conclusion Water leaks in patient areas should be promptly notified to infection
prevention. Detailed investigation to ascertain the actual cause of the leak
and ensure any remedial work could be carried out swiftly. Outbreak meetings
that include diverse people with various expertises (clinical and
non-clinical) can enable prompt identification and resolution of
contaminated areas to minimise risk to patients and staff. During
challenging pandemic periods hospitals must not lose focus on other clusters
and outbreaks occurring simultaneously.
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Affiliation(s)
- Sue Dailly
- Infection Prevention and Control, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Erin Boatswain
- Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Julie Brooks
- Infection Prevention and Control, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Glen Campbell
- Estates, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Katy Dallow
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ahilanandan Dushianthan
- Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Glover
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Melanie Griffiths
- Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sanjay Gupta
- Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - James Austin
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Robert Chambers
- Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Jeremiah
- Infection Prevention and Control, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Charlotte Morris
- Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nitin Mahobia
- Infection Prevention and Control, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Martyn Poxon
- Estates, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alison Rickman
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Helen Jaques
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tatshing Yam
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kordo Saeed
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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25
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Bacterial and Viral Infections in Liver Transplantation: New Insights from Clinical and Surgical Perspectives. Biomedicines 2022; 10:biomedicines10071561. [PMID: 35884867 PMCID: PMC9313066 DOI: 10.3390/biomedicines10071561] [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: 04/12/2022] [Revised: 06/11/2022] [Accepted: 06/27/2022] [Indexed: 01/03/2023] Open
Abstract
End-stage liver disease patients undergoing liver transplantation are prone to develop numerous infectious complications because of immunosuppression, surgical interventions, and malnutrition. Infections in transplant recipients account for the main cause of mortality and morbidity with rates of up to 80%. The challenges faced in the early post-transplant period tend to be linked to transplant procedures and nosocomial infections commonly in bloodstream, surgical, and intra-abdominal sites. Viral infections represent an additional complication of immunosuppression; they can be donor-derived, reactivated from a latent virus, nosocomial or community-acquired. Bacterial and viral infections in solid organ transplantation are managed by prophylaxis, multi-drug resistant screening, risk assessment, vaccination, infection control and antimicrobial stewardship. The aim of this review was to discuss the epidemiology of bacterial and viral infections in liver transplants, infection control issues, as well as surgical frontiers of ex situ liver perfusion.
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26
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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.
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27
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Akcan N, Uyguner O, Baş F, Altunoğlu U, Toksoy G, Karaman B, Avcı Ş, Yavaş Abalı Z, Poyrazoğlu Ş, Aghayev A, Karaman V, Bundak R, Başaran S, Darendeliler F. Mutations in AR or SRD5A2 Genes: Clinical Findings, Endocrine Pitfalls, and Genetic Features of Children with 46,XY DSD. J Clin Res Pediatr Endocrinol 2022; 14:153-171. [PMID: 35135181 PMCID: PMC9176093 DOI: 10.4274/jcrpe.galenos.2022.2021-9-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Androgen insensivity syndrome (AIS) and 5α-reductase deficiency (5α-RD) present with indistinguishable phenotypes among the 46,XY disorders of sexual development (DSD) that usually necessitate molecular analyses for the definitive diagnosis in the prepubertal period. The aim was to evaluate the clinical, hormonal and genetic findings of 46,XY DSD patients who were diagnosed as AIS or 5α-RD. METHODS Patients diagnosed as AIS or 5α-RD according to clinical and hormonal evaluations were investigated. Sequence variants of steroid 5-α-reductase type 2 were analyzed in cases with testosterone/dihydrotestosterone (T/DHT) ratio of ≥20, whereas the androgen receptor (AR) gene was screened when the ratio was <20. Stepwise analysis of other associated genes were screened in cases with no causative variant found in initial analysis. For statistical comparisons, the group was divided into three main groups and subgroups according to their genetic diagnosis and T/DHT ratios. RESULTS A total of 128 DSD patients from 125 non-related families were enrolled. Birth weight SDS and gestational weeks were significantly higher in 5α-RD group than in AIS and undiagnosed groups. Completely female phenotype was higher in all subgroups of both AIS and 5α-RD patients than in the undiagnosed subgroups. In those patients with stimulated T/DHT <20 in the prepubertal period, stimulated T/DHT ratio was significantly lower in AIS than in the undiagnosed group, and higher in 5α-RD. Phenotype associated variants were detected in 24% (n=18 AIS, n=14 5α-RD) of the patients, revealing four novel AR variants (c.94G>T, p.Glu32*, c.330G>C, p.Leu110=; c.2084C>T, p.Pro695Leu, c.2585_2592delAGCTCCTG, p.(Lys862Argfs*16), of these c.330G>C with silent status remained undefined in terms of its causative effects. CONCLUSION T/DHT ratio is an important hormonal criterion, but in some cases, T/DHT ratio may lead to diagnostic confusion. Molecular diagnosis is important for the robust diagnosis of 46,XY DSD patients. Four novel AR variants were identified in our study.
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Affiliation(s)
- Neşe Akcan
- Near East University Faculty of Medicine, Department of Pediatric Endocrinology, Nicosia, Cyprus,* Address for Correspondence: Near East University Faculty of Medicine, Department of Pediatric Endocrinology, Nicosia, Cyprus Phone: +90 392 675 10 00 (1388) E-mail:
| | - Oya Uyguner
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Umut Altunoğlu
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey,Koç University Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Güven Toksoy
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Birsen Karaman
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Şahin Avcı
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey,Koç University Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Zehra Yavaş Abalı
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Agharza Aghayev
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Volkan Karaman
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Rüveyde Bundak
- University of Kyrenia, Faculty of Medicine, Department of Pediatric Endocrinology, Kyrenia, Cyprus
| | - Seher Başaran
- İstanbul University, İstanbul Faculty of Medicine, Department of Medical Genetics, İstanbul, Turkey
| | - Feyza Darendeliler
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
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28
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A New Insight into Nosocomial Infections: a Worldwide Crisis. JOURNAL OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASES 2022. [DOI: 10.52547/jommid.10.2.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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29
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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.
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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
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30
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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.
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A Clustered Case Series of Mucorales Detection in Respiratory Samples from COVID-19 Patients in Intensive Care, France, August to September 2021. J Fungi (Basel) 2022; 8:jof8030258. [PMID: 35330260 PMCID: PMC8948870 DOI: 10.3390/jof8030258] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 12/15/2022] Open
Abstract
While COVID-19-associated pulmonary aspergillosis is now well described in developed countries, COVID-19-associated mucormycosis (CAM) has seemed to remain quite rare in Europe. A retrospective study was performed between March 2020 to September 2021 among COVID-19 adult patients in the intensive care unit (ICU) at Toulouse Hospital (Southern France). PCR screening on respiratory samples, which target Aspergillus or Mucorales DNA, were performed, and the number of fungal detections was evaluated monthly during the study period. During the 19 months of the study, 44 (20.3%) COVID-19 ICU patients had a positive PCR for Aspergillus, an overall rate in keeping with the incidence of ICU COVID-19 patients. Ten patients (7.1%) had a positive Mucorales PCR over the same period. Surprisingly, 9/10 had a positive Mucor/Rhizopus PCR in August-September 2021, during the fourth Delta SARS-CoV-2 variant wave. Epidemic investigations have identified a probable environmental cause linked to construction works in the vicinity of the ICU (high levels of airborne spores due to the mistaken interruption of preventive humidification and summer temperature). Even if CAM are apparently rare in Europe, a cluster can also develop in industrialised countries when environmental conditions (especially during construction work) are associated with a high number of COVID-19 patients in the ICU.
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Khanina A, Tio SY, Ananda‐Rajah MR, Kidd SE, Williams E, Chee L, Urbancic K, Thursky KA. Consensus guidelines for antifungal stewardship, surveillance and infection prevention, 2021. Intern Med J 2021; 51 Suppl 7:18-36. [DOI: 10.1111/imj.15586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Anna Khanina
- National Centre for Infections in Cancer Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology The University of Melbourne Melbourne Victoria Australia
| | - Shio Yen Tio
- National Centre for Infections in Cancer Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology The University of Melbourne Melbourne Victoria Australia
| | - Michelle R. Ananda‐Rajah
- Department of General Medicine Alfred Health Melbourne Victoria Australia
- Department of Infectious Diseases Alfred Health Melbourne Victoria Australia
| | - Sarah E. Kidd
- National Mycology Reference Centre Microbiology and Infectious Diseases, SA Pathology Adelaide South Australia Australia
- School of Biological Sciences University of Adelaide Adelaide South Australia Australia
| | - Eloise Williams
- Department of Microbiology Royal Melbourne Hospital Melbourne Victoria Australia
- Department of Microbiology and Immunology The Peter Doherty Institute for Immunity and Infection, The University of Melbourne Melbourne Parkville Victoria Australia
| | - Lynette Chee
- Department of Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital Melbourne Victoria Australia
- Department of Medicine The University of Melbourne Melbourne Victoria Australia
| | - Karen Urbancic
- National Centre for Infections in Cancer Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Department of Medicine The University of Melbourne Melbourne Victoria Australia
- Pharmacy Department Austin Health Melbourne Victoria Australia
- National Centre for Antimicrobial Stewardship Melbourne Victoria Australia
| | - Karin A. Thursky
- National Centre for Infections in Cancer Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Department of Medicine The University of Melbourne Melbourne Victoria Australia
- National Centre for Antimicrobial Stewardship Melbourne Victoria Australia
- Department of Infectious Diseases Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Victorian Infectious Diseases Service The Peter Doherty Institute for Immunity and Infection, Royal Melbourne Hospital Melbourne Victoria Australia
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Saleem AI, Alsaedi A, Alharbi M, Abdullah S, Al Rabou A, AlDabbagh M. Mucormycosis in pediatric oncology patients: a hospital outbreak investigation report. Infect Prev Pract 2021; 3:100189. [PMID: 34988423 PMCID: PMC8696282 DOI: 10.1016/j.infpip.2021.100189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ahmed I.H. Saleem
- Department of Pediatrics, Division of Infectious Disease, King Abdulaziz Medical City (KAMC-Jeddah), Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Ministry of Health, Saudi Arabia
| | - Asim Alsaedi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (COM, KSAU-HS), Jeddah, Saudi Arabia
- Infection Prevention and Control Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Maher Alharbi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (COM, KSAU-HS), Jeddah, Saudi Arabia
- Infection Prevention and Control Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Shaker Abdullah
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (COM, KSAU-HS), Jeddah, Saudi Arabia
- Department of Oncology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Ali Al Rabou
- Infection Prevention and Control Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mona AlDabbagh
- Department of Pediatrics, Division of Infectious Disease, King Abdulaziz Medical City (KAMC-Jeddah), Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (COM, KSAU-HS), Jeddah, Saudi Arabia
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Almatrafi MA, Aquino VM, Slone T, Huang R, Sebert M. Community Airborne Mold Spore Counts and Invasive Fungal Disease Risk Among Pediatric Hematological Malignancy and Stem Cell Transplant Patients. Open Forum Infect Dis 2021; 8:ofab481. [PMID: 34805427 PMCID: PMC8597966 DOI: 10.1093/ofid/ofab481] [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: 07/03/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background Patients with hematological malignancies and hematopoietic stem cell transplantation (HSCT) recipients are at risk of developing invasive fungal infections, but the quantitative risk posed by exposure to airborne mold spores in the community has not been well characterized. Methods A single-institution, retrospective cohort study was conducted of pediatric patients treated for hematological malignancies and HSCT recipients between 2014 and 2018. Patients with invasive fungal disease (IFD) due to molds or endemic fungi were identified using published case definitions. Daily airborne mold spore counts were obtained from a local National Allergy Bureau monitoring station and tested for association with IFD cases by 0-inflated Poisson regression. Patients residing outside the region or with symptom onset more than 2 weeks after admission were excluded from the primary analysis. Results Sixty cases of proven or probable IFD were identified, of whom 47 cases had symptom onset within 2 weeks of admission and were therefore classified as possible ambulatory onset. The incidence of ambulatory-onset IFD was 1.2 cases per 10000 patient-days (95% CI, 0.9–1.7). A small excess of ambulatory-onset IFD was seen from July through September, during which period spore counts were highest, but this seasonal pattern did not reach statistical significance (P = .09). No significant association was found between IFD cases and community mold spore counts over intervals from 1 to 6 weeks before symptom onset. Conclusions There was no significant association between IFD cases and community airborne mold spore counts among pediatric hematological malignancy and HSCT patients in this region.
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Affiliation(s)
- Mohammed A Almatrafi
- Division of Infectious Diseases, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Pediatrics, Umm Al Qura University, Mecca, Saudi Arabia
| | - Victor M Aquino
- Division of Hematology and Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tamra Slone
- Division of Hematology and Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rong Huang
- Children's Health System of Texas, Dallas, Texas, USA
| | - Michael Sebert
- Division of Infectious Diseases, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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35
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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.
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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.
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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: 12] [Impact Index Per Article: 4.0] [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.
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Cytotoxicity of Aspergillus Section Fumigati Isolated from Health Care Environments. J Fungi (Basel) 2021; 7:jof7100839. [PMID: 34682260 PMCID: PMC8539694 DOI: 10.3390/jof7100839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 01/04/2023] Open
Abstract
This study analyzed 57 Aspergillus section Fumigati (AF) isolates collected by active and passive sampling (N = 450) in several health care facilities and from biological sampling of health care workers (N = 25) and controls (N = 22) in Portugal. All isolates were cultured in different media and screened for azole resistance. Cytotoxicity was assessed for 40 isolates in lung epithelial cells and kidney cells using the MTT assay. Aspergillus section Fumigati was prevalent in the health care facilities and in nasal swabs from health care workers and controls. All AF isolates reduced cell viability and presented medium to high cytotoxicity, with cytotoxicity being significantly higher in A549 lung epithelial cells. The cytotoxicity of isolates from air and nasal swab samples suggested the inhalation route as a risk factor. Notably, 42% of AF isolates exhibited a pattern of reduced susceptibility to some of the most used antifungals available for the treatment of patients infected with these fungi. In sum, the epidemiology and clinical relevance of Aspergillus section Fumigati should continue to be addressed. A deeper understanding of the mechanisms underlying Aspergillus-mediated cytotoxicity is necessary.
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38
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Brackin AP, Hemmings SJ, Fisher MC, Rhodes J. Fungal Genomics in Respiratory Medicine: What, How and When? Mycopathologia 2021; 186:589-608. [PMID: 34490551 PMCID: PMC8421194 DOI: 10.1007/s11046-021-00573-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/14/2021] [Indexed: 12/20/2022]
Abstract
Respiratory infections caused by fungal pathogens present a growing global health concern and are a major cause of death in immunocompromised patients. Worryingly, coronavirus disease-19 (COVID-19) resulting in acute respiratory distress syndrome has been shown to predispose some patients to airborne fungal co-infections. These include secondary pulmonary aspergillosis and mucormycosis. Aspergillosis is most commonly caused by the fungal pathogen Aspergillus fumigatus and primarily treated using the triazole drug group, however in recent years, this fungus has been rapidly gaining resistance against these antifungals. This is of serious clinical concern as multi-azole resistant forms of aspergillosis have a higher risk of mortality when compared against azole-susceptible infections. With the increasing numbers of COVID-19 and other classes of immunocompromised patients, early diagnosis of fungal infections is critical to ensuring patient survival. However, time-limited diagnosis is difficult to achieve with current culture-based methods. Advances within fungal genomics have enabled molecular diagnostic methods to become a fast, reproducible, and cost-effective alternative for diagnosis of respiratory fungal pathogens and detection of antifungal resistance. Here, we describe what techniques are currently available within molecular diagnostics, how they work and when they have been used.
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Affiliation(s)
- Amelie P. Brackin
- MRC Centre for Global Disease Analysis, Imperial College London, London, UK
| | - Sam J. Hemmings
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Matthew C. Fisher
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Johanna Rhodes
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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39
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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.
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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
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40
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Olmsted RN. Reimagining Construction and Renovation of Health Care Facilities During Emergence from a Pandemic. Infect Dis Clin North Am 2021; 35:697-716. [PMID: 34362539 PMCID: PMC8331249 DOI: 10.1016/j.idc.2021.06.001] [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] [Indexed: 10/29/2022]
Abstract
The built environment has been integral to response to the global pandemic of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In particular, engineering controls to mitigate risk of exposure to SARS-CoV-2 and other newly emergent respiratory pathogens in the future will be important. Anticipating emergence from this pandemic, or at least adaptation given increasing administration of effective vaccines, and the safety of patients, personnel, and others in health care facilities remain the core goals. This article summarizes known risks and highlights prevention strategies for daily care as well as response to emergent infectious diseases and this parapandemic phase.
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Affiliation(s)
- Russell N Olmsted
- Integrated Clinical Services (ICS), Trinity Health, Mailstop W3B, 20555 Victor Parkway, Livonia, MI 48152, USA.
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41
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Gandhi P, Benedict K, Toda M, Beer KD, Chiller TM, Jackson BR. 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] [MESH Headings] [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.
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Affiliation(s)
- Pooja Gandhi
- Applied Sciences, Research and Technology, Inc., Smyrna, Georgia
| | - Kaitlin Benedict
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mitsuru Toda
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karlyn D Beer
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tom M Chiller
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brendan R Jackson
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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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.
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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
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Complex and Controversial Roles of Eicosanoids in Fungal Pathogenesis. J Fungi (Basel) 2021; 7:jof7040254. [PMID: 33800694 PMCID: PMC8065571 DOI: 10.3390/jof7040254] [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: 03/02/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 02/02/2023] Open
Abstract
The prevalence of fungal infections has increased in immunocompromised patients, leading to millions of deaths annually. Arachidonic acid (AA) metabolites, such as eicosanoids, play important roles in regulating innate and adaptative immune function, particularly since they can function as virulence factors enhancing fungal colonization and are produced by mammalian and lower eukaryotes, such as yeasts and other fungi (Candida albicans, Histoplasma capsulatum and Cryptococcus neoformans). C. albicans produces prostaglandins (PG), Leukotrienes (LT) and Resolvins (Rvs), whereas the first two have been well documented in Cryptococcus sp. and H. capsulatum. In this review, we cover the eicosanoids produced by the host and fungi during fungal infections. These fungal-derived PGs have immunomodulatory functions analogous to their mammalian counterparts. Prostaglandin E2 (PGE2) protects C. albicans and C. parapsilosis cells from the phagocytic and killing activity of macrophages. H. capsulatum PGs augment the fungal burden and host mortality rates in histoplasmosis. However, PGD2 potentiates the effects and production of LTB4, which is a very potent neutrophil chemoattractant that enhances host responses. Altogether, these data suggest that eicosanoids, mainly PGE2, may serve as a new potential target to combat diverse fungal infections.
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Dadwal SS, Hohl TM, Fisher CE, Boeckh M, Papanicolaou G, Carpenter PA, Fisher BT, Slavin MA, Kontoyiannis DP. American Society of Transplantation and Cellular Therapy Series, 2: Management and Prevention of Aspergillosis in Hematopoietic Cell Transplantation Recipients. Transplant Cell Ther 2021; 27:201-211. [PMID: 33781516 PMCID: PMC9088165 DOI: 10.1016/j.jtct.2020.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022]
Abstract
The Practice Guidelines Committee of the American Society of Transplantation and Cellular Therapy partnered with its Transplant Infectious Disease Special Interest Group to update its 2009 compendium-style infectious disease guidelines for hematopoietic cell transplantation (HCT). A completely fresh approach was taken with the goal of better serving clinical providers by publishing each standalone topic in the infectious disease series as a concise format of frequently asked questions (FAQs), tables, and figures. Adult and pediatric infectious disease and HCT content experts developed, then answered FAQs, and finalized topics with harmonized recommendations that were made by assigning an A through E strength of recommendation paired with a level of supporting evidence graded I through III. This second guideline in the series focuses on invasive aspergillosis, a potentially life-threatening infection in the peri-HCT period. The relevant risk factors, diagnostic considerations, and prophylaxis and treatment approaches are reviewed.
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Affiliation(s)
- Sanjeet S Dadwal
- Division of Infectious Diseases, City of Hope National Medical Center, Duarte, California.
| | - Tobias M Hohl
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cynthia E Fisher
- Division of Infectious Diseases, University of Washington, Seattle, Washington
| | - Michael Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Genofeva Papanicolaou
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Brian T Fisher
- Division of Pediatric Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania
| | - Monica A Slavin
- Department of Infectious Disease, and National Center for Infections in Cancer, Peter McCallum Cancer Center, Melbourne, Victoria, Australia
| | - D P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
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45
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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.
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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
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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]
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47
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Abdolrasouli A, Gibani MM, de Groot T, Borman AM, Hoffman P, Azadian BS, Mughal N, Moore LSP, Johnson EM, Meis JF. A pseudo-outbreak of Rhinocladiella similis in a bronchoscopy unit of a tertiary care teaching hospital in London, United Kingdom. Mycoses 2020; 64:394-404. [PMID: 33314345 DOI: 10.1111/myc.13227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 01/15/2023]
Abstract
Outbreaks of fungal infections due to emerging and rare species are increasingly reported in healthcare settings. We investigated a pseudo-outbreak of Rhinocladiella similis in a bronchoscopy unit of a tertiary care teaching hospital in London, UK. We aimed to determine route of healthcare-associated transmission and prevent additional infections. From July 2018 through February 2019, we detected a pseudo-outbreak of R. similis isolated from bronchoalveolar lavage (BAL) fluid samples collected from nine patients who had undergone bronchoscopy in a multispecialty teaching hospital, during a period of 8 months. Isolates were identified by MALDI-TOF mass spectrometry. Antifungal susceptibility testing was performed by EUCAST broth microdilution. To determine genetic relatedness among R. similis isolates, we undertook amplified fragment length polymorphism analysis. To determine the potential source of contamination, an epidemiological investigation was carried out. We reviewed patient records retrospectively and audited steps taken during bronchoscopy as well as the subsequent cleaning and decontamination procedures. Fungal cultures were performed on samples collected from bronchoscopes and automated endoscope washer-disinfector systems. No patient was found to have an infection due to R. similis either before or after bronchoscopy. One bronchoscope was identified to be used among all affected patients with positive fungal cultures. Physical damage was found in the index bronchoscope; however, no fungus was recovered after sampling of the affected scope or the rinse water of automated endoscope washer-disinfectors. Use of the scope was halted, and, during the following 12-month period, Rhinocladiella species were not isolated from any BAL specimen. All pseudo-outbreak isolates were identified as R. similis with high genetic relatedness (>90% similarity) on ALFP analysis. The study emphasises the emergence of a rare and uncommon black yeast R. similis, with reduced susceptibility to echinocandins, in a bronchoscope-related pseudo-outbreak with a potential water-related reservoir. Our findings highlight the importance of prolonged fungal culture and species-level identification of melanised yeasts isolated from bronchoscopy samples. Possibility of healthcare-associated transmission should be considered when R. similis is involved in clinical microbiology samples.
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Affiliation(s)
- Alireza Abdolrasouli
- Department of Medical Microbiology, King's College Hospital NHS Foundation Trust, London, UK.,Department of Infectious Diseases, Imperial College London, London, UK
| | - Malick M Gibani
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Theun de Groot
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands
| | - Andrew M Borman
- National Mycology Reference Laboratory, Public Health England, Bristol, UK.,Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Peter Hoffman
- HCAI & AMR Division, National Infection Service, Public Health England, London, UK
| | - Berge S Azadian
- Chelsea and Westminster National Health Service (NHS) Foundation Trust, London, UK
| | - Nabeela Mughal
- Department of Infectious Diseases, Imperial College London, London, UK.,Chelsea and Westminster National Health Service (NHS) Foundation Trust, London, UK.,North West London Pathology, Imperial College Healthcare NHS Trust, London, UK
| | - Luke S P Moore
- Department of Infectious Diseases, Imperial College London, London, UK.,Chelsea and Westminster National Health Service (NHS) Foundation Trust, London, UK.,North West London Pathology, Imperial College Healthcare NHS Trust, London, UK
| | - Elizabeth M Johnson
- National Mycology Reference Laboratory, Public Health England, Bristol, UK.,Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands.,Bioprocess Engineering and Biotechnology Graduate Program, Federal University of Paraná, Curitiba, Brazil.,Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
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48
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An overview of research on air and environmental contamination with SARS-CoV-2 in healthcare settings. Infect Control Hosp Epidemiol 2020; 43:130-133. [PMID: 33298221 PMCID: PMC8485011 DOI: 10.1017/ice.2020.1366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ghosh PN, Brookes LM, Edwards HM, Fisher MC, Jervis P, Kappel D, Sewell TR, Shelton JM, Skelly E, Rhodes JL. Cross-Disciplinary Genomics Approaches to Studying Emerging Fungal Infections. Life (Basel) 2020; 10:E315. [PMID: 33260763 PMCID: PMC7761180 DOI: 10.3390/life10120315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/15/2020] [Accepted: 11/19/2020] [Indexed: 11/16/2022] Open
Abstract
Emerging fungal pathogens pose a serious, global and growing threat to food supply systems, wild ecosystems, and human health. However, historic chronic underinvestment in their research has resulted in a limited understanding of their epidemiology relative to bacterial and viral pathogens. Therefore, the untargeted nature of genomics and, more widely, -omics approaches is particularly attractive in addressing the threats posed by and illuminating the biology of these pathogens. Typically, research into plant, human and wildlife mycoses have been largely separated, with limited dialogue between disciplines. However, many serious mycoses facing the world today have common traits irrespective of host species, such as plastic genomes; wide host ranges; large population sizes and an ability to persist outside the host. These commonalities mean that -omics approaches that have been productively applied in one sphere and may also provide important insights in others, where these approaches may have historically been underutilised. In this review, we consider the advances made with genomics approaches in the fields of plant pathology, human medicine and wildlife health and the progress made in linking genomes to other -omics datatypes and sets; we identify the current barriers to linking -omics approaches and how these are being underutilised in each field; and we consider how and which -omics methodologies it is most crucial to build capacity for in the near future.
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Affiliation(s)
- Pria N. Ghosh
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis, St Mary’s Campus, Imperial College London, London W2 1PG, UK; (L.M.B.); (H.M.E.); (M.C.F.); (P.J.); (D.K.); (T.R.S.); (J.M.G.S.); (E.S.); (J.L.R.)
- Unit for Environmental Sciences and Management, North-West University, Potchefstroom 2520, South Africa
| | - Lola M. Brookes
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis, St Mary’s Campus, Imperial College London, London W2 1PG, UK; (L.M.B.); (H.M.E.); (M.C.F.); (P.J.); (D.K.); (T.R.S.); (J.M.G.S.); (E.S.); (J.L.R.)
- Institute of Zoology, Zoological Society of London, London NW1 4RY, UK
- Royal Veterinary College, Hawkshead Lane, North Mymms, Herts AL9 7TA, UK
| | - Hannah M. Edwards
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis, St Mary’s Campus, Imperial College London, London W2 1PG, UK; (L.M.B.); (H.M.E.); (M.C.F.); (P.J.); (D.K.); (T.R.S.); (J.M.G.S.); (E.S.); (J.L.R.)
| | - Matthew C. Fisher
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis, St Mary’s Campus, Imperial College London, London W2 1PG, UK; (L.M.B.); (H.M.E.); (M.C.F.); (P.J.); (D.K.); (T.R.S.); (J.M.G.S.); (E.S.); (J.L.R.)
| | - Phillip Jervis
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis, St Mary’s Campus, Imperial College London, London W2 1PG, UK; (L.M.B.); (H.M.E.); (M.C.F.); (P.J.); (D.K.); (T.R.S.); (J.M.G.S.); (E.S.); (J.L.R.)
- Institute of Zoology, Zoological Society of London, London NW1 4RY, UK
- Department of Chemistry, University College London, London WC1H 0AJ, UK
| | - Dana Kappel
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis, St Mary’s Campus, Imperial College London, London W2 1PG, UK; (L.M.B.); (H.M.E.); (M.C.F.); (P.J.); (D.K.); (T.R.S.); (J.M.G.S.); (E.S.); (J.L.R.)
| | - Thomas R. Sewell
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis, St Mary’s Campus, Imperial College London, London W2 1PG, UK; (L.M.B.); (H.M.E.); (M.C.F.); (P.J.); (D.K.); (T.R.S.); (J.M.G.S.); (E.S.); (J.L.R.)
| | - Jennifer M.G. Shelton
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis, St Mary’s Campus, Imperial College London, London W2 1PG, UK; (L.M.B.); (H.M.E.); (M.C.F.); (P.J.); (D.K.); (T.R.S.); (J.M.G.S.); (E.S.); (J.L.R.)
- UK Centre for Ecology & Hydrology, Wallingford OX10 8BB, UK
| | - Emily Skelly
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis, St Mary’s Campus, Imperial College London, London W2 1PG, UK; (L.M.B.); (H.M.E.); (M.C.F.); (P.J.); (D.K.); (T.R.S.); (J.M.G.S.); (E.S.); (J.L.R.)
| | - Johanna L. Rhodes
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis, St Mary’s Campus, Imperial College London, London W2 1PG, UK; (L.M.B.); (H.M.E.); (M.C.F.); (P.J.); (D.K.); (T.R.S.); (J.M.G.S.); (E.S.); (J.L.R.)
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Bacigalupo A, Metafuni E, Amato V, Marquez Algaba E, Pagano L. Reducing infectious complications after allogeneic stem cell transplant. Expert Rev Hematol 2020; 13:1235-1251. [PMID: 32996342 DOI: 10.1080/17474086.2020.1831382] [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] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Infections remain a significant problem, in patients undergoing an allogeneic hematopoietic stem-cell transplant (HSCT) and efforts have been made over the years, to reduce the incidence, morbidity and mortality of infectious complications. AREAS COVERED This manuscript is focused on the epidemiology, risk factors and prevention of infections after allogeneic HSCT. A systematic literature review was performed using the PubMed database, between November 2019 and January 2020, with the following MeSH terms: stem-cell transplantation, infection, fungal, bacterial, viral, prophylaxis, vaccines, prevention. The authors reviewed all the publications, and following a common revision, a summary report was made and results were divided in three sections: bacterial, fungal and viral infections. EXPERT OPINION Different infections occur in the early, intermediate and late post-transplant period, due to distinct risk factors. Improved diagnostic techniques, pre-emtive therapy and better prophylaxis of immunologic complications, have reduced the morbidity and mortality of infections. The role of the gut microbiota is under careful scrutiny and may further help us to identify high-risk patients.
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Affiliation(s)
- Andrea Bacigalupo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli- IRCCS , Rome, Italy
| | - Elisabetta Metafuni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli- IRCCS , Rome, Italy
| | - Viviana Amato
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli- IRCCS , Rome, Italy
| | - Ester Marquez Algaba
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona , Barcelona, Spain
| | - Livio Pagano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli- IRCCS , Rome, Italy.,Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica Del Sacro Cuore , Rome, Italy
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