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Nosocomial aspergillosis in outbreak settings.
1Institute for Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Germany. Vonberg.Ralf@MH-Hannover.de
The Journal of Hospital Infection
|May 23, 2006
Summary
Nosocomial aspergillosis, a serious threat to immunocompromised patients, is often caused by airborne Aspergillus spores from construction. Even low spore concentrations can trigger outbreaks, highlighting the need for exposure prevention.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Hospital Epidemiology
Background:
- Nosocomial aspergillosis poses a significant risk to immunocompromised individuals.
- Numerous outbreaks of invasive aspergillosis have been documented in healthcare settings.
Purpose of the Study:
- To systematically review characteristics and mortality of patients with nosocomial aspergillosis.
- To analyze the distribution of Aspergillus species and spore concentrations in clinical and air samples.
- To identify common sources of Aspergillus outbreaks in hospitals.
Main Methods:
- Systematic search of a web-based outbreak register, PubMed, and reference lists.
- Inclusion of 53 studies comprising 458 patients with nosocomial aspergillosis.
- Analysis of patient demographics, underlying conditions, infection sites, causative Aspergillus species, and outbreak sources.
Main Results:
- The lower respiratory tract was the primary infection site in 356 patients.
- Aspergillus fumigatus and Aspergillus flavus were the most frequently identified species.
- Haematological malignancies were the predominant underlying disease, with a higher fatality rate (57.6%) compared to non-immunocompromised patients (39.4%).
- Construction or demolition work was implicated as the source in 49.1% of outbreaks.
- Infections occurred even with Aspergillus spp. concentrations below 1 CFU/m³.
Conclusions:
- Airborne sources, primarily construction, are the main cause of nosocomial aspergillosis outbreaks.
- Low concentrations of Aspergillus spores can lead to infections in high-risk patients.
- Preventing exposure to airborne Aspergillus is crucial for at-risk patient populations.