1
|
Douglas AP, Stewart AG, Halliday CL, Chen SCA. Outbreaks of Fungal Infections in Hospitals: Epidemiology, Detection, and Management. J Fungi (Basel) 2023; 9:1059. [PMID: 37998865 PMCID: PMC10672668 DOI: 10.3390/jof9111059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
Nosocomial clusters of fungal infections, whilst uncommon, cannot be predicted and are associated with significant morbidity and mortality. Here, we review reports of nosocomial outbreaks of invasive fungal disease to glean insight into their epidemiology, risks for infection, methods employed in outbreak detection including genomic testing to confirm the outbreak, and approaches to clinical and infection control management. Both yeasts and filamentous fungi cause outbreaks, with each having general and specific risks. The early detection and confirmation of the outbreak are essential for diagnosis, treatment of affected patients, and termination of the outbreak. Environmental sampling, including the air in mould outbreaks, for the pathogen may be indicated. The genetic analysis of epidemiologically linked isolates is strongly recommended through a sufficiently discriminatory approach such as whole genome sequencing or a method that is acceptably discriminatory for that pathogen. An analysis of both linked isolates and epidemiologically unrelated strains is required to enable genetic similarity comparisons. The management of the outbreak encompasses input from a multi-disciplinary team with epidemiological investigation and infection control measures, including screening for additional cases, patient cohorting, and strict hygiene and cleaning procedures. Automated methods for fungal infection surveillance would greatly aid earlier outbreak detection and should be a focus of research.
Collapse
Affiliation(s)
- Abby P. Douglas
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC 3084, Australia
| | - Adam G. Stewart
- Centre for Clinical Research, Faculty of Medicine, Royal Brisbane and Women’s Hospital Campus, The University of Queensland, Herston, QLD 4006, Australia;
| | - Catriona L. Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, NSW 2145, Australia; (C.L.H.); (S.C.-A.C.)
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, NSW 2145, Australia; (C.L.H.); (S.C.-A.C.)
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Mulliken JS, Hampshire KN, Rappold AG, Fung M, Babik JM, Doernberg SB. Risk of systemic fungal infections after exposure to wildfires: a population-based, retrospective study in California. Lancet Planet Health 2023; 7:e381-e386. [PMID: 37164514 DOI: 10.1016/s2542-5196(23)00046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Large-scale wildfires in California, USA, are increasing in both size and frequency, with substantial health consequences. The capacity for wildfire smoke to displace microbes and cause clinically significant fungal infections is poorly understood. We aimed to determine whether exposure to wildfire smoke was associated with an increased risk of hospital admissions for systemic fungal infections. METHODS In this population-based, retrospective study, we used hospital administrative data from 22 hospitals in California, USA, to analyse the association between wildfire smoke exposure and monthly hospital admissions for aspergillosis and coccidioidomycosis. We included hospitals that were members of the Vizient Clinical Data Base or Resource Manager during the study and excluded those that did not have complete reporting into Vizient during the study period. Smoke exposure was estimated using satellite-imaged smoke plumes in the hospital county. Incident rate ratios were calculated for all infection types 1 month and 3 months after smoke exposure. FINDINGS Between Oct 1, 2014, and May 31, 2018, there were a median of 1638 annual admissions per hospital in the study sample. Individual patient demographics were not collected. We did not observe an association between smoke exposure and rate of hospital admission for aspergillosis. However, hospital admission for coccidioidomycosis increased by 20% (95% CI 5-38) in the month following any smoke exposure. Hospital admission increased by 2% (0-4) for every day that there had been smoke exposure in the previous month, after adjustment for temperature and temporal trend. Similar results were obtained with smoke exposure data from the 3 months before admission. INTERPRETATION In the months following wildfire smoke exposure, California hospitals saw increased coccidioidomycosis infections. Given the projected increase in California wildfires and their expansion in endemic territories of soil-dwelling fungi, the ability for wildfire smoke to carry microbes and cause human disease warrants further research. FUNDING None.
Collapse
Affiliation(s)
| | | | - Ana G Rappold
- United States Environmental Protection Agency, Durham, NC, USA
| | - Monica Fung
- University of California San Francisco, San Francisco, CA, USA
| | | | | |
Collapse
|
4
|
Parker RA, Gabriel KT, Graham KD, Butts BK, Cornelison CT. Antifungal Activity of Select Essential Oils against Candida auris and Their Interactions with Antifungal Drugs. Pathogens 2022; 11:pathogens11080821. [PMID: 35894044 PMCID: PMC9331469 DOI: 10.3390/pathogens11080821] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022] Open
Abstract
Candida auris is an emerging fungal pathogen that commonly causes nosocomial blood infections in the immunocompromised. Several factors make this pathogen a global threat, including its misidentification as closely related species, its ability to survive for weeks on fomites, and its resistance to commonly prescribed antifungal drugs, sometimes to all three classes of systemic antifungal drugs. These factors demonstrate a need for the development of novel therapeutic approaches to combat this pathogen. In the present study, the antifungal activities of 21 essential oils were tested against C. auris. Several essential oils were observed to inhibit the growth and kill C. auris, Candida lusitaniae, and Saccharomyces cerevisiae when in direct contact and at concentrations considered safe for topical use. The most effective essential oils were those extracted from lemongrass, clove bud, and cinnamon bark. These essential oils also elicited antifungal activity in gaseous form. The efficacies of formulations comprised of these three essential oils in combination with fluconazole, amphotericin B, flucytosine, and micafungin were explored. While synergism was neither observed with cinnamon bark oil nor any of the antifungal drugs, lemongrass oil displayed synergistic, additive, and indifferent interactions with select drugs. Formulations of clove bud oil with amphotericin B resulted in antagonistic interactions but displayed synergistic interactions with fluconazole and flucytosine. These essential oils and their combinations with antifungal drugs may provide useful options for surface disinfection, skin sanitization, and possibly even the treatment of Candida infections.
Collapse
|
5
|
COVID-19 Associated Pulmonary Aspergillosis (CAPA): Hospital or Home Environment as a Source of Life-Threatening Aspergillus fumigatus Infection? J Fungi (Basel) 2022; 8:jof8030316. [PMID: 35330318 PMCID: PMC8952274 DOI: 10.3390/jof8030316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 02/02/2023] Open
Abstract
Most cases of invasive aspergillosis are caused by Aspergillus fumigatus, whose conidia are ubiquitous in the environment. Additionally, in indoor environments, such as houses or hospitals, conidia are frequently detected too. Hospital-acquired aspergillosis is usually associated with airborne fungal contamination of the hospital air, especially after building construction events. A. fumigatus strain typing can fulfill many needs both in clinical settings and otherwise. The high incidence of aspergillosis in COVID patients from our hospital, made us wonder if they were hospital-acquired aspergillosis. The purpose of this study was to evaluate whether the hospital environment was the source of aspergillosis infection in CAPA patients, admitted to the Hospital Universitario Central de Asturias, during the first and second wave of the COVID-19 pandemic, or whether it was community-acquired aspergillosis before admission. During 2020, sixty-nine A. fumigatus strains were collected for this study: 59 were clinical isolates from 28 COVID-19 patients, and 10 strains were environmentally isolated from seven hospital rooms and intensive care units. A diagnosis of pulmonary aspergillosis was based on the ECCM/ISHAM criteria. Strains were genotyped by PCR amplification and sequencing of a panel of four hypervariable tandem repeats within exons of surface protein coding genes (TRESPERG). A total of seven genotypes among the 10 environmental strains and 28 genotypes among the 59 clinical strains were identified. Genotyping revealed that only one environmental A. fumigatus from UCI 5 (box 54) isolated in October (30 October 2020) and one A. fumigatus isolated from a COVID-19 patient admitted in Pneumology (Room 532-B) in November (24 November 2020) had the same genotype, but there was a significant difference in time and location. There was also no relationship in time and location between similar A. fumigatus genotypes of patients. The global A. fumigatus, environmental and clinical isolates, showed a wide diversity of genotypes. To our knowledge, this is the first study monitoring and genotyping A. fumigatus isolates obtained from hospital air and COVID-19 patients, admitted with aspergillosis, during one year. Our work shows that patients do not acquire A. fumigatus in the hospital. This proves that COVID-associated aspergillosis in our hospital is not a nosocomial infection, but supports the hypothesis of “community aspergillosis” acquisition outside the hospital, having the home environment (pandemic period at home) as the main suspected focus of infection.
Collapse
|
6
|
Almansob A, Bahkali AH, Ameen F. Efficacy of Gold Nanoparticles against Drug-Resistant Nosocomial Fungal Pathogens and Their Extracellular Enzymes: Resistance Profiling towards Established Antifungal Agents. NANOMATERIALS 2022; 12:nano12050814. [PMID: 35269303 PMCID: PMC8912448 DOI: 10.3390/nano12050814] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023]
Abstract
Drug resistance of filamentous fungi to the commonly used antifungal agents is a major concern in medicine. Therefore, an effective approach to treat several opportunistic fungal infections is the need of the hour. Mentha piperita is used in home remedies to treat different disorders. Isolates of fungi were taken from hospitals in Riyadh, Saudi Arabia, and identified using molecular tools. Amphotericin B, Voriconazole, and Micafungin were applied to screen the resistance of these isolates using both disc and broth microdilution techniques. An aqueous extract of Mentha piperita was utilized to synthesize AuNPs and the nanoparticles were characterized using UV-Vis, FTIR, TEM, EDAX, and XRD. The AuNPs were tested for antifungal activity against the nosocomial fungal pathogens and the activity of extracellular enzymes of such pathogens were analyzed after treatment with AuNPs. We conclude that AuNPs synthesized using Mentha piperita do not possess especially effective antifungal properties against multi-drug resistant Aspergillus species. Five out of eighteen isolates were inhibited by AuNPs. When inhibition was observed, significant alterations in the activity profile of extracellular enzymes of the nosocomial fungi were observed.
Collapse
|
7
|
Büchner F, Hoffman M, Dobermann UH, Edel B, Lehmann T, Kipp F. Do closed waste containers lead to less air contamination than opened? A clinical case study at Jena University Hospital, Germany. WASTE MANAGEMENT (NEW YORK, N.Y.) 2021; 136:11-17. [PMID: 34634566 DOI: 10.1016/j.wasman.2021.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/13/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
Nosocomial infections are a growing challenge at hospitals. This clinical study aimed to investigate the influence of waste container construction ((open (O), closed (C), and hands-free opening (HF)) on microbial air contamination in a hospital setting. The results are intended to help develop guidelines for waste containers for the collection of non-infectious waste at hospitals and medical facilities. The clinical experiment was conducted at the University Hospital Jena, Germany. Air Impactor samples were performed and microbiologically evaluated for bacteria and fungi both quantitatively and qualitatively. The results were statistically determined using generalized estimating equations. Quantitatively, the lowest bacterial counts in ambient air were found around closed waste containers (114.74 CFU/m3) in comparison to HF (129.28 CFU/m3) and O (126.28 CFU/m3). For fungi, the surrounding air of C (2.08 CFU/m3) and HF (1.97 CFU/m3) waste containers showed a lower impact of fungal air contamination than for O (2.32 CFU/m3). Overall, it was shown that C are more preferable to HF and O waste containers from the point of view of microbial air contamination at hospitals.
Collapse
Affiliation(s)
- Franziskus Büchner
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, D-07747 Jena, Germany.
| | - Marc Hoffman
- Integrative Health and Security Management Center, Staff Section Environmental Protection, Jena University Hospital, Bachstraße 18, D-07743 Jena, Germany
| | - Ute-Helke Dobermann
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, D-07747 Jena, Germany
| | - Birgit Edel
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, D-07747 Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Bachstraße 18, D-07743 Jena, Germany
| | - Frank Kipp
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, D-07747 Jena, Germany
| |
Collapse
|
8
|
Jain N, Jansone I, Obidenova T, Sīmanis R, Meisters J, Straupmane D, Reinis A. Epidemiological Characterization of Clinical Fungal Isolates from Pauls Stradinš Clinical University Hospital, Latvia: A 4-Year Surveillance Report. Life (Basel) 2021; 11:1002. [PMID: 34685374 PMCID: PMC8537438 DOI: 10.3390/life11101002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022] Open
Abstract
Nosocomial fungal infections are an emerging global public health threat that requires urgent attention and proper management. With the limited availability of treatment options, it has become necessary to understand the emerging epidemiological trends, mechanisms, and risk factors. However, very limited surveillance reports are available in the Latvian and broader European context. We therefore conducted a retrospective analysis of laboratory data (2017-2020) from Pauls Stradinš Clinical University Hospital (PSCUH), Riga, Latvia, which is one of the largest public multispecialty hospitals in Latvia. A total of 2278 fungal isolates were analyzed during the study period, with Candida spp. comprising 95% of the isolates, followed by Aspergillus spp. and Geotrichum spp. Amongst the Candida spp., C. albicans and C. glabrata made up about 75% of the isolates. The Department of Lung Diseases and Thoracic Surgery had the highest caseload followed by Intensive Care Department. Majority of the fungal isolates were collected from the bronchoalveolar lavage (37%), followed by urine (19%) and sputum (18%) samples. A total of 34 cases of candidemia were noted during the study period with C. albicans being the most common candidemia pathogen. Proper surveillance of emerging epidemiological trends serve as the most reliable and powerful cornerstone towards tackling this emerging threat.
Collapse
Affiliation(s)
- Nityanand Jain
- Department of Biology and Microbiology, Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
| | - Inese Jansone
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
| | - Tatjana Obidenova
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
| | - Raimonds Sīmanis
- Department of Infectology, Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
| | - Jānis Meisters
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
| | - Dagnija Straupmane
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
| | - Aigars Reinis
- Department of Biology and Microbiology, Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
| |
Collapse
|
9
|
Ghelfenstein-Ferreira T, Saade A, Alanio A, Bretagne S, Araujo de Castro R, Hamane S, Azoulay E, Bredin S, Dellière S. Recovery of a triazole-resistant Aspergillus fumigatus in respiratory specimen of COVID-19 patient in ICU - A case report. Med Mycol Case Rep 2020; 31:15-18. [PMID: 32837880 PMCID: PMC7331532 DOI: 10.1016/j.mmcr.2020.06.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022] Open
Abstract
Although invasive pulmonary aspergillosis (IPA) is typically described in immunocompromised host, patient with severe influenzae can develop IPA. Similarly, patients with severe COVID-19 complicated with IPA are increasingly reported. Here, we describe a case of invasive aspergillosis with triazole-resistant A. fumigatus (TR34/L98H mutation) in a 56-year-old patient with COVID-19 in intensive care unit. This report highlights the need to define the available tools for diagnosis of invasive aspergillosis in severe COVID-19 patients. Association between COVID-19 and invasive aspergillosis. Early screening for aspergillosis should be performed in respiratory specimen. This case emphasizes the need to screen isolates for pan-azole resistance.
Collapse
Affiliation(s)
| | - Anastasia Saade
- Médecine Intensive et Réanimation, Hôpital Saint-Louis (AP-HP), Université de Paris, France
| | - Alexandre Alanio
- Laboratoire de Parasitologie - Mycologie, Hôpital Saint-Louis (AP-HP), Université de Paris, France.,Unité de Mycologie Moléculaire, Institut Pasteur, CNRS URA 3012, Centre National de Référence des Mycoses Invasives et des Antifongiques, URA, 3012, Paris, France
| | - Stéphane Bretagne
- Laboratoire de Parasitologie - Mycologie, Hôpital Saint-Louis (AP-HP), Université de Paris, France.,Unité de Mycologie Moléculaire, Institut Pasteur, CNRS URA 3012, Centre National de Référence des Mycoses Invasives et des Antifongiques, URA, 3012, Paris, France
| | - Raffael Araujo de Castro
- Unité de Mycologie Moléculaire, Institut Pasteur, CNRS URA 3012, Centre National de Référence des Mycoses Invasives et des Antifongiques, URA, 3012, Paris, France
| | - Samia Hamane
- Laboratoire de Parasitologie - Mycologie, Hôpital Saint-Louis (AP-HP), Université de Paris, France
| | - Elie Azoulay
- Médecine Intensive et Réanimation, Hôpital Saint-Louis (AP-HP), Université de Paris, France
| | - Swann Bredin
- Médecine Intensive et Réanimation, Hôpital Saint-Louis (AP-HP), Université de Paris, France
| | - Sarah Dellière
- Laboratoire de Parasitologie - Mycologie, Hôpital Saint-Louis (AP-HP), Université de Paris, France
| |
Collapse
|
10
|
Basso M, Zago D, Pozzetto I, De Canale E, Scaggiante R, Biasolo MA, Peracchi M, Onelia F, Baldasso E, Palù G, Parisi SG. Intra-hospital acquisition of colonization and infection by Klebsiella pneumoniae strains producing carbapenemases and carriage evolution: A longitudinal analysis in an Italian teaching hospital from January 2017 to August 2019. Int J Infect Dis 2020; 92:81-88. [PMID: 31935535 DOI: 10.1016/j.ijid.2019.12.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/23/2019] [Accepted: 12/24/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We present an updated picture (1/1/2017-31/08/2019) of the frequency of carbapenemase producing Klebsiella pneumoniae (CPKP) in surveillance rectal swabs (SRS) and in clinical samples (CS) of patients admitted to a tertiary level hospital, focusing on longitudinal evolution of CPKP detected in SRS and on colistin resistant strains. METHODS Retrospective longitudinal analysis. Only the first positive CPKP strain isolated from each patient was included. RESULTS 638 CPKP strains were identified (471 in SRS and 167 in CS). SRS frequency increased over time in the medical department, remained high in the surgical department (SD) and decreased in the intensive care department. Most SRS-71.3%-and 49.1% of CS had nosocomial origin; about half of the SRS were identified in the SD. Regarding SRS evolution, carriage was confirmed in 39.5% of patients, no more testing in 25.5%, clinical involvement in 24.8 %, and negative result in 10.2%. Rates of colistin resistance were 20.1% in 2017, 31.2% in 2018 and 26.9% in 2019. CONCLUSIONS CPKP diffusion is still an important issue despite the surveillance program. It is vital to enhance medical staff's awareness on this because most CPKP first detections in SRS occurred during hospital stay due to a nosocomial acquisition with a comparable picture over time. Colistin resistance is increasing.
Collapse
Affiliation(s)
- Monica Basso
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy.
| | - Daniela Zago
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy.
| | - Irene Pozzetto
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy.
| | - Ettore De Canale
- Microbiology and Virology Unit, Padova University Hospital, Via Giustiniani 2, 35128 Padova, Italy.
| | - Renzo Scaggiante
- Infectious Diseases Unit, Padova University Hospital, Via Giustiniani 2, 35128 Padova, Italy.
| | - Maria Angela Biasolo
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy.
| | - Marta Peracchi
- Microbiology and Virology Unit, Padova University Hospital, Via Giustiniani 2, 35128 Padova, Italy.
| | - Francesco Onelia
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy.
| | - Elisa Baldasso
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy.
| | - Giorgio Palù
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy.
| | - Saverio Giuseppe Parisi
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy.
| |
Collapse
|
11
|
Loeffert ST, Melloul E, Dananché C, Hénaff L, Bénet T, Cassier P, Dupont D, Guillot J, Botterel F, Wallon M, Gustin MP, Vanhems P. Monitoring of clinical strains and environmental fungal aerocontamination to prevent invasive aspergillosis infections in hospital during large deconstruction work: a protocol study. BMJ Open 2017; 7:e018109. [PMID: 29175886 PMCID: PMC5719317 DOI: 10.1136/bmjopen-2017-018109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Monitoring fungal aerocontamination is an essential measure to prevent severe invasive aspergillosis (IA) infections in hospitals. One central block among 32 blocks of Edouard Herriot Hospital (EHH) was entirely demolished in 2015, while care activities continued in surrounding blocks. The main objective was to undertake broad environmental monitoring and clinical surveillance of IA cases to document fungal dispersion during major deconstruction work and to assess clinical risk. METHODS AND ANALYSIS A daily environmental survey of fungal loads was conducted in eight wards located near the demolition site. Air was collected inside and outside selected wards by agar impact samplers. Daily spore concentrations were monitored continuously by volumetric samplers at a flow rate of 10 L.min-1. Daily temperature, wind direction and speed as well as relative humidity were recorded by the French meteorological station Meteociel. Aspergillus fumigatus strains stored will be genotyped by multiple-locus, variable-number, tandem-repeat analysis. Antifungal susceptibility will be assessed by E-test strips on Roswell Park Memorial Institute medium supplemented with agar. Ascertaining the adequacy of current environmental monitoring techniques in hospital is of growing importance, considering the rising impact of fungal infections and of curative antifungal costs. The present study could improve the daily management of IA risk during major deconstruction work and generate new data to ameliorate and redefine current guidelines. ETHICS AND DISSEMINATION This study was approved by the clinical research and ethics committees of EHH.
Collapse
Affiliation(s)
- Sophie Tiphaine Loeffert
- Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Lyon, France
| | - Elise Melloul
- EA 7380 Dynamyc, EnvA, UPEC, Université Paris Est, Créteil, France
| | - Cédric Dananché
- Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Lyon, France
- Unité d'hygiène, épidémiologie et prévention, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | - Laetitia Hénaff
- Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Lyon, France
| | - Thomas Bénet
- Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Lyon, France
- Unité d'hygiène, épidémiologie et prévention, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | - Pierre Cassier
- Laboratoire de Biologie Sécurité Environnement, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | - Damien Dupont
- Institut de Parasitologie et de Mycologie Médicale, Hôpital de la Croix Rousse, Lyon, France
| | - Jacques Guillot
- EA 7380 Dynamyc, EnvA, UPEC, Université Paris Est, Créteil, France
| | | | - Martine Wallon
- Institut de Parasitologie et de Mycologie Médicale, Hôpital de la Croix Rousse, Lyon, France
| | - Marie-Paule Gustin
- Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Lyon, France
- Département de santé Publique, Institut des Sciences Pharmaceutiques et Biologiques (ISPB)-Faculté de Pharmacie, Université de Lyon, Lyon, France
| | - Philippe Vanhems
- Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Lyon, France
- Unité d'hygiène, épidémiologie et prévention, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
12
|
Gonçalves SS. Global Aspects of Triazole Resistance in Aspergillus fumigatus with Focus on Latin American Countries. J Fungi (Basel) 2017; 3:jof3010005. [PMID: 29371524 PMCID: PMC5715964 DOI: 10.3390/jof3010005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 12/30/2022] Open
Abstract
Azole resistance in Aspergillus has emerged as an escalating problem in health care, and it has been detected in patients exposed, or not, to these drugs. It is known that azole antifungals are widely applied not only in clinical treatments for fungal infections, but also as agricultural fungicides, resulting in a significant threat for human health. Although the number of cases of azole-resistant aspergillosis is still limited, various resistance mechanisms are described from clinical and environmental isolates. These mechanisms consist mainly of alterations in the target of azole action (CYP51A gene)—specifically on TR34/L98H and TR46/Y121F/T289A, which are responsible for over 90% of resistance cases. This review summarizes the epidemiology, management, and extension of azole resistance in A. fumigatus worldwide and its potential impact in Latin American countries, emphasizing its relevance to clinical practice.
Collapse
Affiliation(s)
- Sarah Santos Gonçalves
- Center for Research in Medical Mycology, Department of Pathology, Universidade Federal do Espírito Santo-UFES, Av. Marechal Campos, 1468, Maruípe CEP 29.040-090, Vitória-ES, Brazil.
| |
Collapse
|
13
|
|
14
|
Tyagi R, Dey P. Aspergillus involving submandibular salivary gland: An unusual presentation. J Cytol 2014; 31:181-2. [PMID: 25538395 PMCID: PMC4274537 DOI: 10.4103/0970-9371.145671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ruchita Tyagi
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
15
|
Desoubeaux G, Bernard MC, Gros V, Sarradin P, Perrodeau E, Vecellio L, Piscopo A, Chandenier J, Bernard L. Testing an innovative device against airborne Aspergillus contamination. Med Mycol 2014; 52:584-90. [PMID: 24965945 DOI: 10.1093/mmy/myu011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aspergillus fumigatus is a major airborne nosocomial pathogen that is responsible for severe mycosis in immunocompromised patients. We studied the efficacy of an innovative mobile air-treatment device in eliminating A. fumigatus from the air following experimental massive contamination in a high-security room. Viable mycological particles were isolated from sequential air samples in order to evaluate the device's effectiveness in removing the fungus. The concentration of airborne conidia was reduced by 95% in 18 min. Contamination was reduced below the detection threshold in 29 min, even when the machine was at the lowest airflow setting. In contrast, during spontaneous settling with no air treatment, conidia remained airborne for more than 1 h. This indoor air contamination model provided consistent and reproducible results. Because the air purifier proved to be effective at eliminating a major contaminant, it may prove useful in preventing air-transmitted disease agents. In an experimental space mimicking a hospital room, the AirLyse air purifier, which uses a combination of germicidal ultraviolet C irradiation and titanium photocatalysis, effectively eliminated Aspergillus conidia. Such a mobile device may be useful in routine practice for lowering microbiological air contamination in the rooms of patients at risk.
Collapse
Affiliation(s)
- Guillaume Desoubeaux
- Department of Parasitology-Mycology-Tropical Medicine, Centre Hospitalier Régional Universitaire, Tours, France Unité Mixte de Recherche, Institut National de la Santé et de la Recherche Médicale U1100, Equipe d'Accueil 6305, University of François Rabelais School of Medicine, Tours, France
| | - Marie-Charlotte Bernard
- Unité Mixte de Recherche, Institut National de la Santé et de la Recherche Médicale U1100, Equipe d'Accueil 6305, University of François Rabelais School of Medicine, Tours, France AirLyse, Saint-Avertin, France
| | - Valérie Gros
- Laboratoire des Sciences du Climat et de l'Environnement, Institut Pierre-Simon Laplace, Commissariat à l'Energie Atomique, Centre National de la Recherche Scientifique, Université de Versailles Saint-Quentin-en-Yveline, Gif-sur-Yvette, France
| | - Pierre Sarradin
- Institut National de la Recherche Agronomique, Unité d'Enseignement 1277, Nouzilly, France
| | - Elodie Perrodeau
- Department of Clinical Investigation, Centre Hospitalier Régional Universitaire, Tours, France
| | - Laurent Vecellio
- Unité Mixte de Recherche, Institut National de la Santé et de la Recherche Médicale U1100, Equipe d'Accueil 6305, University of François Rabelais School of Medicine, Tours, France Diffusion Technique Française, Aerodrug, Tours, France
| | | | - Jacques Chandenier
- Department of Parasitology-Mycology-Tropical Medicine, Centre Hospitalier Régional Universitaire, Tours, France Unité Mixte de Recherche, Institut National de la Santé et de la Recherche Médicale U1100, Equipe d'Accueil 6305, University of François Rabelais School of Medicine, Tours, France
| | - Louis Bernard
- Unité Mixte de Recherche, Institut National de la Santé et de la Recherche Médicale U1100, Equipe d'Accueil 6305, University of François Rabelais School of Medicine, Tours, France Department of Internal Medicine & Infectious Disease, Centre Hospitalier Régional Universitaire, Tours, France
| |
Collapse
|
16
|
Marfenina OE, Fomicheva GM, Gorlenko MV, Svirida NM. Ecophysiological differences between saprotrophic and clinical strains of the microscopic fungus Aspergillus sydowii (Bainier & Sartory) Thom & Church. Microbiology (Reading) 2013. [DOI: 10.1134/s0026261713010086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
17
|
Seven-year surveillance of nosocomial invasive aspergillosis in a French University Hospital. J Infect 2012; 65:559-67. [DOI: 10.1016/j.jinf.2012.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 07/19/2012] [Accepted: 08/08/2012] [Indexed: 11/24/2022]
|
18
|
Leleu C, Menotti J, Meneceur P, Choukri F, Sulahian A, Garin YJF, Derouin F. Efficacy of liposomal amphotericin B for prophylaxis of acute or reactivation models of invasive pulmonary aspergillosis. Mycoses 2012; 56:241-9. [DOI: 10.1111/myc.12011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
19
|
Brenier-Pinchart MP, Lebeau B, Borel JL, Quesada JL, Mallaret M, Garban F, Brion JP, Molina L, Bosson JL, Thiebaut-Bertrand A, Grillot R, Pelloux H. Community-acquired invasive aspergillosis and outdoor filamentous fungal spore load: a relationship? Clin Microbiol Infect 2011; 17:1387-90. [DOI: 10.1111/j.1469-0691.2011.03523.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|