Reduction of Invasive Aspergillosis Incidence among Immunocompromised Patients after Control of Environmental Exposure

Bénet, Thomas; Nicolle, Marie-Christine; Thiébaut, Anne; Piens, Marie‐Antoinette; Nicolini, Franck‐Emmanuel; Thomas, Xavier; Picot, Stéphane; Michallet, Mauricette; Vanhems, Philippe

doi:10.1086/521378

Cited by 74 publications

(52 citation statements)

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“…specially ventilated rooms) in the department. 21 Moreover, the decrease of IA incidence was most probably not due to a lower incidence of Aspergillus antigen or a reduced number of positive CT scans. Indeed, Aspergillus antigen was usually investigated in patients two times a week according to a local protocol.…”

Section: Discussionmentioning

confidence: 93%

“…A detailed description of this surveillance can be found elsewhere. 21 For the present study, the data were censored at December 31, 2009. Multiple sources allowed us to identify suspected IA with the highest sensitivity.…”

Section: Study Design and Data Sourcesmentioning

confidence: 99%

“…10 IA incidence varies according to underlying hematologic disease and studies reported, being between 5% and 24% in acute leukemia patients [11][12][13][14] and between 3% and 11% in allogeneic stem cell transplantation. [15][16][17] Medical prophylaxis with posaconazole [18][19] and/or prevention strategies taking environmental factors into account [20][21] could have contributed to a decrease in IA incidence. However, to the best of our knowledge, this IA incidence trend has not yet been described.…”

Section: Introductionmentioning

confidence: 99%

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Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009

Nicolle¹,

Bénet²,

Thiébaut³

et al. 2011

Haematologica

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BackgroundThe study objectives were: 1) to report on invasive aspergillosis patients in a hematology department; and 2) to estimate its incidence according to the hematologic diagnosis. Design and MethodsA prospective survey of invasive aspergillosis cases was undertaken between January 2004 and December 2009 in the hematology department of a university hospital. Meetings with clinicians, mycologists and infection control practitioners were organized monthly to confirm suspected aspergillosis cases. Demographic characteristics, clinical and complementary examination results were recorded prospectively. Information on hospitalization was extracted from administrative databases. Invasive aspergillosis diagnosis followed the European Organization for Research and Treatment of Cancer criteria, and proven and probable IA cases were retained. A descriptive analysis was conducted with temporal trends of invasive aspergillosis incidence assessed by adjusted Poisson regression. ResultsOverall, 4,073 hospitalized patients (78,360 patient-days) were included in the study. In total, 127 (3.1%) patients presented invasive aspergillosis. The overall incidence was 1.6 per 1,000 patient-days (95% confidence interval: 1.4, 1.9) with a decrease of 16% per year (-1%, -28%). The incidence was 1.9 per 1,000 patient-days (1.5, 2.3) in acute myeloid leukemia patients with a decrease of 20% per year (-6%, -36%). Serum Aspergillus antigen was detected in 89 (71%) patients; 29 (23%) had positive cultures, and 118 (93%), abnormal lung CT scans. One-month mortality was 13%; 3-month mortality was 42%. Mortality tended to decrease between 2004 and 2009. ConclusionsInvasive aspergillosis incidence and mortality declined between 2004 and 2009. Knowledge of invasive aspergillosis characteristics and its clinical course should help to improve the management of these patients with severe disease.Key words: invasive aspergillosis, surveillance, hematologic disease, incidence, hospital. 2004 . Haematologica 2011 96(11):1685-1691. doi:10.3324/haematol.2011 Citation: Nicolle M-C, Bénet T, Thiebaut A, Bienvenu A-L, Voirin N, Duclos A, Sobh M, Cannas G, Thomas X, Nicolini F-E, De Monbrison F, Piens M-A, Picot S, Michallet M, and Vanhems P. Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from

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Section: Discussionmentioning

confidence: 93%

Section: Study Design and Data Sourcesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009

Nicolle¹,

Bénet²,

Thiébaut³

et al. 2011

Haematologica

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“…11 It is somewhat controversial whether the amount of fungal spores in the air correlates with the risk of IA or not, but in some studies this has been the case. 10,28 The HSCT ward air quality issues only relate to early IA infections, diagnosed within the first month after transplantation when patients are hospitalized. The results of air quality monitoring in this study should be interpreted with some reservation as only settled dust analysis was used.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] Placing patients in HEPAfiltered rooms clearly protects patients, as air filtration has been shown to decrease the number of fungal spores in the air and the incidence of IA. [10][11][12] In HEPA-filtrated rooms, however, low levels of spores sometimes remain. 11 Also, only about 30% of IA infections are nowadays seen in the first month after the transplantation.…”

Section: Introductionmentioning

confidence: 99%

Invasive Aspergillus infections in allo-SCT recipients: environmental sampling, nasal and oral colonization and galactomannan testing

Nihtinen

Anttila

Richardson³

et al. 2009

Bone Marrow Transplant

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A study was performed to investigate the air quality of a haematopoietic SCT ward, colonization of the upper airways with Aspergillus spp. and the role of galactomannan (GM) ELISA testing in serum in the diagnosis of invasive aspergillosis (IA). In 102 allo-SCT recipients, two cases of IA (one proven and one probable) were seen. Of 2071 serum samples, 12 were positive, two in a patient with proven IA and 10 in patients without IA. Of the 2059 negative samples, 22 were taken from the patient with probable IA. Of the 245 environmental samples, 20 (8.2%) were positive for filamentous fungi. Aspergillus fumigatus was seen in 14 samples. A total of 657 oral and nasal swabs were taken. Seven nasal samples and one oral sample were positive for Aspergillus species (A. fumigatus 4, A. niger 4) in four patients, one of whom had probable IA. In summary, most environmental samples were negative, colonization of the oral and nasal cavities was rare and IA was diagnosed in only 2% of patients. The GM ELISA test remained negative in one of two patients with IA and does not seem useful in a population of patients with a low incidence of IA.

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Infection Prevention – Protected Environment and Infection Control

Donnelly

2011

Principles and Practice of Cancer Infectious Diseases

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Reduction of Invasive Aspergillosis Incidence among Immunocompromised Patients after Control of Environmental Exposure

Abstract: We detected a straightforward association between environmental modification and decreased IA incidence, which emphasizes the use of an environmental strategy, including high-efficiency air filtration, in the prevention of IA.

Cited by 74 publications

References 11 publications

Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009

Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009

Invasive Aspergillus infections in allo-SCT recipients: environmental sampling, nasal and oral colonization and galactomannan testing

Infection Prevention – Protected Environment and Infection Control

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