Relationship between environmental fungal contamination and the incidence of invasive aspergillosis in haematology patients

• Published in: The Journal of hospital infection Vol. 48; no. 3; pp. 198 - 206
• Main Authors: Alberti, C., Bouakline, A., Ribaud, P., Lacroix, C., Rousselot, P., Leblanc, T., Derouin, F.
• Format: Journal Article
• Language: English
• Published: Kent Elsevier Ltd 01-07-2001; Elsevier
• Subjects: Aspergillosis - complications; Aspergillosis - epidemiology; Aspergillus; Aspergillus - isolation & purification; Biological and medical sciences; Bone Marrow Transplantation; Cross Infection - epidemiology; disease transmission; Environmental Exposure; Environmental Microbiology; Hematologic Diseases - complications; hematological diseases; Hospital Units - statistics & numerical data; Human mycoses; Humans; Infectious diseases; Medical sciences; Mycoses; Mycotic sepsis; nosocomial infection; Opportunistic Infections - complications; Opportunistic Infections - epidemiology; Prospective Studies; Human; Mycosis; Ambient medium; Air; Contamination; Incidence; Surface; Infection; Microbiological investigation; Aspergillosis; Risk factor; Environment; Disseminated; Hospital
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1053/jhin.2001.0998

Invasive aspergillosis (IA) is a major opportunistic infection in haematology patients. Spore inhalation is the usual route of Aspergillus infection, suggesting a determining role of environmental contamination by spores in the epidemiology of IA. We prospectively examined the relationship between environmental contamination by Aspergillus and other fungal species and the incidence of invasive nosocomial aspergillosis (INA) in a bone marrow transplantation unit and two haematology wards. During a four-year period, levels of air and surface fungal contamination were determined bi-monthly in patients' rooms(some equipped with HEPA filters and LAF systems), and various common sites in each ward (corridors, nursing stations, etc.). Results were compared to the incidence of INA. A total of 3100 air and 9800 surface samples were collected, and 79 cases of IA were diagnosed, of which 64 were probably or possibly INA. Patterns of fungal contamination were comparable in the three wards, with a gradient ranging fromhigh levels in common sites to a virtual absence in rooms equipped with HEPA filters and LAF systems. Using a regression model, a significant relationship was found between the incidence of INA and the degree of fungal contamination of air and surfaces in conventional patient rooms (not equipped with HEPA) and common sites. This study shows that in a non-epidemic setting, there is a significant relationship between environmental fungal contamination in haematology wards and the incidence of INA. Ourfindings underline the importance of environmental surveillance and strict application of preventivemeasures.