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Published on: March 22, 2012
Nosocomial aspergillosis in outbreak settings
1Institute for Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Germany. Vonberg.Ralf@MH-Hannover.de
Abstract:
Nosocomial aspergillosis represents a serious threat for severely immunocompromised patients and numerous outbreaks of invasive aspergillosis have been described. This systematic review summarizes characteristics and mortality rates of infected patients, distribution of Aspergillus spp. in clinical specimens, concentrations of aspergillus spores in volumetric air samples, and outbreak sources. A web-based register of nosocomial epidemics (outbreak database), PubMed and reference lists of relevant articles were searched systematically for descriptions of aspergillus outbreaks in hospital settings. Fifty-three studies with a total of 458 patients were included. In 356 patients, the lower respiratory tract was the primary site of aspergillus infection. Species identified most often were Aspergillus fumigatus (154 patients) and Aspergillus flavus (101 patients). Haematological malignancies were the predominant underlying diseases (299 individuals). The overall fatality rate in these 299 patients (57.6%) was significantly greater than that in patients without severe immunodeficiency (39.4% of 38 individuals). Construction or demolition work was often (49.1%) considered to be the probable or possible source of the outbreak. Even concentrations of Aspergillus spp. below 1 colony-forming unit/m(3) were sufficient to cause infection in high-risk patients. Virtually all outbreaks of nosocomial aspergillosis are attributed to airborne sources, usually construction. Even small concentrations of spores have been associated with outbreaks, mainly due to A. fumigatus or A. flavus. Patients at risk should not be exposed to aspergilli.
Insights
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.
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