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Invasive Aspergillus spp infections in rheumatology patients
D O Garrett1, E Jochimsen, W Jarvis
1Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Objective:
The number of immunocompromised patients in hospitals has increased, resulting in a concomitant increase in the number of Aspergillus spp infections, with an exceedingly high death rate. From January 1995 through June 1996, 7 patients acquired invasive aspergillosis at a Maryland hospital (Hospital A). No cases had been detected in 1994.
Methods:
To determine risk factors for infection, we conducted a case-control study and an environmental evaluation. A case was defined as histopathologic evidence of invasive Aspergillus spp infection in any Hospital A patient admitted from January 1994 through July 1996.
Results:
Of 7 case patients identified, 5 were rheumatology patients hospitalized on 2 wards. Rheumatology case patients were more likely than randomly selected rheumatology patients without invasive Aspergillus spp infection (controls) to die (p = 0.004), to have longer hospitalization both in current (p = 0.008) and prior (p = 0.001) admissions, to receive high doses of intravenous immunosuppressive agents (p = 0.03), or to receive immunosuppressive agents for a longer period of time (p = 0.001). The environmental evaluation showed that construction areas were neither sealed off from patient care areas nor under negative pressure relative to patient-care areas. The air flow from patients' rooms was not positive in relation to the hallway and had only 1.6 air changes per hour.
Conclusion:
This investigation suggests that rheumatology patients, particularly those receiving high dose intravenous immunosuppressive agents, are at increased risk of invasive Aspergillus spp infection. A high index of suspicion for the diagnosis of nosocomial aspergillosis should be maintained in these patients and, when hospitalized, they should be assigned to rooms removed from or physically separated from construction activity.
Insights
Immunocompromised patients, especially those in rheumatology receiving immunosuppressive agents, face a high risk of invasive Aspergillus infections. Hospital environmental factors, like construction, may contribute to these dangerous nosocomial infections.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Mycology
Background:
- Rising incidence of immunocompromised patients leads to increased hospital-acquired Aspergillus infections.
- Invasive aspergillosis carries an exceptionally high mortality rate.
- Seven cases of invasive aspergillosis were identified at a Maryland hospital between January 1995 and June 1996.
Purpose of the Study:
- To identify risk factors associated with invasive Aspergillus infections in hospitalized patients.
- To investigate the potential role of environmental factors in the transmission of Aspergillus species.
Main Methods:
- A case-control study was conducted comparing infected patients (cases) with uninfected patients (controls).
- Environmental assessments were performed to evaluate potential sources and transmission routes of Aspergillus.
- Cases were defined by histopathologic evidence of invasive Aspergillus infection.
Main Results:
- Five of the seven identified cases were rheumatology patients.
- Rheumatology patients with invasive aspergillosis had significantly higher mortality rates, longer hospitalizations, and received more intensive immunosuppressive therapy.
- Environmental evaluation revealed inadequate containment of construction areas and poor air exchange rates in patient rooms.
Conclusions:
- Rheumatology patients, particularly those on high-dose immunosuppressive therapy, are at elevated risk for invasive Aspergillus infections.
- A high index of suspicion is crucial for diagnosing nosocomial aspergillosis in at-risk patients.
- Hospitalized patients should be located away from construction zones to minimize exposure risk.