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An outbreak of aspergillosis in a general ITU
H Humphreys1, E M Johnson, D W Warnock
1Department of Microbiology, Bristol Royal Infirmary.
Abstract:
Over a 5-month period, six patients in a general intensive therapy unit became colonized by Aspergillus species including Aspergillus fumigatus, and invasive infection occurred in at least two of them. Broncho-alveolar lavage was unhelpful in discriminating between infection and colonization. The source of infection was presumed to be disturbance of an accumulation of spores in fibrous insulation material above the perforated metal ceiling. Patients in such units without clearly identifiable defects of defence against infection may be at risk from aspergillosis. The risk can be reduced by improved hospital design, satisfactory ventilation and thorough regular cleaning of environmental surfaces.
Insights
Intensive care units may harbor Aspergillus, causing colonization and invasive infections in patients. Environmental controls, including hospital design and cleaning, are crucial for preventing aspergillosis spread.
Area of Science:
- Medical Mycology
- Hospital Epidemiology
- Infectious Diseases
Background:
- Aspergillus species, including Aspergillus fumigatus, can colonize patients in intensive therapy units.
- Invasive aspergillosis poses a significant risk to critically ill patients.
- Environmental contamination in healthcare settings is a potential source of fungal infections.
Purpose of the Study:
- To investigate the incidence of Aspergillus colonization and invasive infection in a general intensive therapy unit.
- To evaluate the effectiveness of broncho-alveolar lavage in differentiating infection from colonization.
- To identify potential environmental sources and risk factors for aspergillosis in this setting.
Main Methods:
- Prospective surveillance of patients in a general intensive therapy unit over a 5-month period.
- Microbiological sampling and analysis of respiratory specimens (broncho-alveolar lavage).
- Environmental assessment to identify potential sources of Aspergillus spores.
Main Results:
- Six patients developed Aspergillus colonization; at least two experienced invasive infection.
- Broncho-alveolar lavage proved insufficient for distinguishing between colonization and invasive infection.
- A suspected source was disturbed fibrous insulation material containing Aspergillus spores above a ceiling.
Conclusions:
- Critically ill patients in intensive therapy units are at risk of aspergillosis, even without obvious immune defects.
- Improved hospital design, effective ventilation, and rigorous cleaning are essential to mitigate aspergillosis risk.
- Environmental control measures are vital for preventing fungal infections in healthcare environments.