Airborne Aspergillus fumigatus spore concentration during demolition of a building on a hospital site, and patient risk determination for invasive aspergillosis including azole resistance

Wirmann, L; Ross, Birgit; Reimann, O; Steinmann, Joerg; Pm, Rath

doi:10.1016/j.jhin.2018.07.030

Cited by 25 publications

(21 citation statements)

References 33 publications

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“…Countries reporting the presence of azole-resistant Aspergillus fumigatus and mechanisms of resistance in surveyed isolates [47,48,49,52,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97]. …”

Section: Figurementioning

confidence: 99%

Emerging Fungal Infections: New Patients, New Patterns, and New Pathogens

Friedman

Schwartz

2019

JoF

256

200

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: The landscape of clinical mycology is constantly changing. New therapies for malignant and autoimmune diseases have led to new risk factors for unusual mycoses. Invasive candidiasis is increasingly caused by non-albicans Candida spp., including C. auris, a multidrug-resistant yeast with the potential for nosocomial transmission that has rapidly spread globally. The use of mould-active antifungal prophylaxis in patients with cancer or transplantation has decreased the incidence of invasive fungal disease, but shifted the balance of mould disease in these patients to those from non-fumigatus Aspergillus species, Mucorales, and Scedosporium/Lomentospora spp. The agricultural application of triazole pesticides has driven an emergence of azole-resistant A. fumigatus in environmental and clinical isolates. The widespread use of topical antifungals with corticosteroids in India has resulted in Trichophyton mentagrophytes causing recalcitrant dermatophytosis. New dimorphic fungal pathogens have emerged, including Emergomyces, which cause disseminated mycoses globally, primarily in HIV infected patients, and Blastomyces helicus and B. percursus, causes of atypical blastomycosis in western parts of North America and in Africa, respectively. In North America, regions of geographic risk for coccidioidomycosis, histoplasmosis, and blastomycosis have expanded, possibly related to climate change. In Brazil, zoonotic sporotrichosis caused by Sporothrix brasiliensis has emerged as an important disease of felines and people.

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Section: Figurementioning

confidence: 99%

Emerging Fungal Infections: New Patients, New Patterns, and New Pathogens

Friedman

Schwartz

2019

JoF

256

200

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“…However, Aspergillus spp. spore concentration did not correlate with various meteorological data, such as temperature, precipitation, and humidity [13, 20, 22], although there were some reports about seasonal variation of Aspergillus spp. spore levels [24, 25].…”

Section: Discussionmentioning

confidence: 99%

“…isolated from the clinical and air samples. It remains a difficult task to identify a direct epidemiological linkage between environmental and clinical fungal isolates, with two recent studies showing conflicting results on the correlation between A. fumigatus spore levels in the air and the incidence of IA during constructions in hospitals [12, 13]. Further studies are needed to clarify the genomic correlation between environmental and clinical fungal isolates.…”

Section: Discussionmentioning

confidence: 99%

“…It is recommended that clinicians conduct active surveillance for airborne fungal infection in high-risk patients and that wards for these patients should be equipped with appropriate ventilation systems based on infection-control risk assessment during construction periods [6]. However, it remains controversial whether elevated fungal spore level assessed by air sampling during construction works in hospitals is associated with the increased risk of IA [10, 12, 13], although it is well known that construction works in hospitals have been associated with IA outbreaks [8, 10, 11]. Therefore, the recommendation of routine microbiologic air sampling before, during, or after construction is still under debate.…”

Section: Introductionmentioning

confidence: 99%

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Airborne fungal spores and invasive aspergillosis in hematologic units in a tertiary hospital during construction: a prospective cohort study

Park

Ryu

Lee

et al. 2019

Antimicrob Resist Infect Control

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Background Invasive aspergillosis (IA) is an opportunistic fungal infection that mostly occurs in immunocompromised patients, such as those having hematologic malignancy or receiving hematopoietic stem cell transplantation. Inhalation of Aspergillus spores is the main transmission route of IA in immunocompromised patients. Construction work in hospitals is a risk factor for environmental fungal contamination. We measured airborne fungal contamination and the incidence of IA among immunocompromised patients, and evaluated their correlation with different types of construction works. Methods Our tertiary hospital in Seoul, Korea underwent facility construction from September 2017 to February 2018. We divided the entire construction period into period 1 (heavier works: demolition and excavation) and period 2 (lighter works: framing, interior designing, plumbing, and finishing). We conducted monthly air sampling for environmental spore surveillance in three hematologic wards. We evaluated the incidence of IA among all immunocompromised patients hospitalized in the three hematologic wards (2 adult wards and 1 pediatric ward) during this period. IA was categorized into proven, probable, and possible aspergillosis based on the revised European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG) criteria. Results A total of 15 patients was diagnosed with proven (1 case), probable (8 cases), or possible (6 cases) hospital-acquired IA during period 1. In period 2, 14 patients were diagnosed with either proven (1 case), probable (10 cases), or possible (3 cases) hospital-acquired IA. Total mold and Aspergillus spp. spore levels in the air tended to be higher in period 1 ( p = 0.06 and 0.48, respectively). The incidence rate of all IA by the EORTC/MSG criteria was significantly higher in period 1 than in period 2 (1.891 vs. 0.930 per 1000 person-days, p = 0.05). Conclusions Airborne fungal spore levels tended to be higher during the period with heavier construction works involving demolition and excavation, during which the incidence of IA was significantly higher as well. We recommend monitoring airborne fungal spore levels during construction periods in hospitals with immunocompromised patients. Subsequently, the effect of airborne fungal spore level monitoring in reducing hospital-acquired IA should be evaluated. Electronic supplementary material The online version of this article (10.1186/s13756-019-0543-1) contains supplementary material, which is available to authorized users.

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“…Hospital-acquired aspergillosis is associated with environmental contamination, with genetic diversity reportedly high among indoor sampling sites, particularly during renovations [10,35,[78][79][80][81][82][83][84][85][86]. For example, Aspergillus spp.…”

Section: Routes Of Transmissionmentioning

confidence: 99%

Molecular Epidemiology of Aspergillus fumigatus in Chronic Pulmonary Aspergillosis Patients

Torre

Shen

Rautemaa‐Richardson

et al. 2021

JoF

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Molecular fungal genotyping techniques developed and employed for epidemiological studies have understandably concentrated on establishing the genetic diversity of Aspergillus fumigatus in invasive aspergillosis due to its severity, the urgency for treatment, and the need to demonstrate possible sources. Some early studies suggested that these strains were phenotypically, if not genotypically, different from others. However, with improved discrimination and evaluations, incorporating environmental as well as clinical isolates from other Aspergillus conditions (e.g., chronic pulmonary aspergillosis and cystic fibrosis), this premise is no longer upheld. Moreover, with the onset of increased global triazole resistance, there has been a concerted effort to incorporate resistance profiling into genotyping studies and the realisation that the wider population of non-immunocompromised aspergillosis patients are at risk. This review summarises the developments in molecular genotyping studies that incorporate resistance profiling with attention to chronic pulmonary aspergillosis and an example of our UK experience.

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Airborne Aspergillus fumigatus spore concentration during demolition of a building on a hospital site, and patient risk determination for invasive aspergillosis including azole resistance

Cited by 25 publications

References 33 publications

Emerging Fungal Infections: New Patients, New Patterns, and New Pathogens

Emerging Fungal Infections: New Patients, New Patterns, and New Pathogens

Airborne fungal spores and invasive aspergillosis in hematologic units in a tertiary hospital during construction: a prospective cohort study

Molecular Epidemiology of Aspergillus fumigatus in Chronic Pulmonary Aspergillosis Patients

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