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Construction activity: an independent risk factor for invasive aspergillosis and zygomycosis in patients with
Abstract:
Between November 1982 and July 1984, five patients at a 110-bed pediatric hospital were diagnosed with invasive filamentous fungal infection; three had invasive aspergillosis (IA) and two had invasive zygomycosis (IZ). All five had underlying hematologic malignancy (HM). In a case-control study, these five HM patients (cases) were compared to 10 autopsied HM patients without evidence of aspergillosis or zygomycosis (controls). Cases and controls did not differ in underlying disease or in the degree of immunosuppression, as measured by duration of granulocytopenia and number of platelet transfusions. However, case-patients were more likely than controls to have been hospitalized during the construction of a hospital addition (p less than 0.02, Fisher's exact test [FET]). Four (80%) of five HM patients autopsied during the period of construction had IA or IZ compared with one (5%) of 21 autopsied before construction began (p = 0.001, FET). These findings suggest that, in a population of comparably immunosuppressed patients, construction activity may represent an independent risk factor for IA or IZ. Hospitals caring for such patients should take precautions which minimize exposure of these patients to construction or renovation activity.
Insights
Hospital construction may increase the risk of invasive filamentous fungal infections, such as invasive aspergillosis (IA) and invasive zygomycosis (IZ), in immunocompromised patients with hematologic malignancy (HM). Precautions are recommended during renovations.
Area of Science:
- Medical Mycology
- Hospital Epidemiology
- Infectious Diseases
Background:
- Invasive filamentous fungal infections pose a significant threat to immunocompromised patients.
- Hematologic malignancy (HM) is a common underlying condition associated with increased fungal infection risk.
Purpose of the Study:
- To investigate potential risk factors for invasive filamentous fungal infections in pediatric patients with hematologic malignancy.
- To assess the association between hospital construction and the incidence of invasive aspergillosis (IA) and invasive zygomycosis (IZ).
Main Methods:
- A case-control study was conducted comparing five HM patients with IA or IZ to 10 HM patients without these infections.
- Patients were compared based on underlying disease, degree of immunosuppression, and hospitalization during hospital construction.
- Fisher's exact test (FET) was used for statistical analysis.
Main Results:
- Patients diagnosed with IA or IZ were significantly more likely to have been hospitalized during hospital construction (p < 0.02).
- A higher proportion of autopsied HM patients (80%) had IA or IZ during the construction period compared to before construction (5%) (p = 0.001).
- No significant differences were found in underlying disease or immunosuppression levels between cases and controls.
Conclusions:
- Hospital construction activity may be an independent risk factor for IA and IZ in immunocompromised HM patients.
- Hospitals should implement measures to minimize patient exposure to construction or renovation activities.
- Further research is warranted to understand the specific mechanisms linking construction to fungal infections.