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Pathogenic Aspergillus species recovered from a hospital water system: a 3-year prospective study
Elias J Anaissie1, Shawna L Stratton, M Cecilia Dignani
1Myeloma and Transplantation Research Center, Arkansas Cancer Research Center, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA. anaissieeliasj@uams.edu
Abstract:
Nosocomial aspergillosis, a life-threatening infection in immunocompromised patients, is thought to be caused primarily by Aspergillus organisms in the air. A 3-year prospective study of the air, environmental surfaces, and water distribution system of a hospital in which there were known cases of aspergillosis was conducted to determine other possible sources of infection. Aspergillus species were found in the hospital water system. Significantly higher concentrations of airborne aspergillus propagules were found in bathrooms, where water use was highest (2.95 colony-forming units [cfu]/m(3)) than in patient rooms (0.78 cfu/m(3); P=.05) and in hallways (0.61 cfu/m(3); P=.03). A correlation was found between the rank orders of Aspergillus species recovered from hospital water and air. Water from tanks yielded higher counts of colony-forming units than did municipal water. An isolate of Aspergillus fumigatus recovered from a patient with aspergillosis was genotypically identical to an isolate recovered from the shower wall in the patient's room. In addition to the air, hospital water systems may be a source of nosocomial aspergillosis.
Insights
Hospital water systems, not just air, may spread Aspergillus infections in immunocompromised patients. This study found Aspergillus in water and higher airborne levels in bathrooms, linking water to nosocomial aspergillosis.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Environmental Health
Background:
- Nosocomial aspergillosis is a severe infection in immunocompromised individuals, typically attributed to airborne Aspergillus.
- A 3-year prospective study investigated potential sources of Aspergillus beyond airborne transmission in a hospital setting.
Observation:
- Aspergillus species were identified within the hospital's water distribution system.
- Airborne Aspergillus concentrations were significantly higher in bathrooms compared to patient rooms and hallways.
- Water tanks showed higher colony-forming unit counts than municipal water sources.
Findings:
- A correlation exists between Aspergillus species found in hospital water and airborne samples.
- Genotypic analysis confirmed an Aspergillus fumigatus isolate from a patient matched an isolate from a shower wall in their room.
- Hospital water systems represent a potential reservoir for nosocomial aspergillosis.
Implications:
- Findings suggest hospital water systems are a significant, underrecognized source of nosocomial aspergillosis.
- This highlights the need for enhanced water system surveillance and control measures to prevent infections.
- Further research into waterborne Aspergillus transmission is warranted to protect vulnerable patient populations.