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Detection of Invasive Pulmonary Aspergillosis in Haematological Malignancy Patients by using Lateral-flow Technology
Published on: March 22, 2012
Post-surgical invasive aspergillosis: an uncommon and under-appreciated entity
Julia Jensen1, Jesús Guinea, Marta Torres-Narbona
1Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain.
Objective:
Post-surgical invasive aspergillosis (PSIA) is an unusual and underestimated complication of surgery. It may occur after colonization of surgical sites by airborne Aspergillus conidia during surgery, or in the immediate postoperative.
Methods:
We reviewed 7 cases of PSIA (1997-2006) and checked the air levels of Aspergillus conidia in the operating rooms and/or areas surrounding 5/7 patients.
Results:
PSIA accounted for 8.4% (n = 83) of all cases of invasive aspergillosis. Patients had no classic predisposing conditions (wound infection (n = 4), mediastinitis (n = 2), and endotipsitis with endocarditis (n = 1)). PSIA occurred sporadically after heart, thoracic, and vascular prosthetic surgery. Aspergillus fumigatus was involved in all cases. Median time from surgery to diagnosis was 25 days. Galactomannan was only positive (> or =1 ng/mL) in 2 patients (endotipsitis with endocarditis and mediastinitis). Mortality was 100% in cases of organ/space post-surgical infections. Although the air of operating rooms taken before surgery was free of Aspergillus, airborne Aspergillus conidia levels were high (>95 CFU/m(3)) in the rooms of 2 patients.
Conclusions:
PSIA represented almost 10% of all cases of invasive aspergillosis. Our cases were not linked to high levels of Aspergillus conidia in the operating rooms but to postoperative contamination by environmental isolates present in high counts.
Insights
Post-surgical invasive aspergillosis (PSIA) is a rare complication, often due to environmental contamination after surgery. This study highlights its occurrence and risk factors in surgical patients.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Surgical Infections
Background:
- Post-surgical invasive aspergillosis (PSIA) is an uncommon but serious complication.
- It can arise from intraoperative or immediate postoperative contamination by Aspergillus conidia.
Purpose of the Study:
- To investigate the characteristics and risk factors of PSIA.
- To assess the role of airborne Aspergillus conidia in operating rooms and patient environments.
Main Methods:
- A retrospective review of 7 PSIA cases between 1997 and 2006.
- Air sampling for Aspergillus conidia in operating rooms and surrounding areas for 5 patients.
Main Results:
- PSIA represented 8.4% of all invasive aspergillosis cases.
- Cases occurred after cardiac, thoracic, and vascular prosthetic surgery, primarily caused by Aspergillus fumigatus.
- Mortality was 100% for organ/space infections; contamination was linked to postoperative environmental factors, not pre-operative air quality.
Conclusions:
- PSIA constitutes nearly 10% of invasive aspergillosis cases.
- Contamination often stems from environmental sources post-surgery, rather than high levels of airborne conidia during operations.
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