Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-26T16:57:04.223Z Has data issue: false hasContentIssue false
  • English
  • Français

Hospital Epidemiologic Surveillance for Invasive Aspergillosis: Patient Demographics and the Utility of Antigen Detection

Published online by Cambridge University Press:  02 January 2015

Jan Evans Patterson ,
Ahmed Zidouh ,
Peggy Miniter ,
Vincent T. Andriole  and
Thomas F. Patterson
Jan Evans Patterson*
Affiliation:
Departments of Medicine (Infectious Diseases) and Epidemiology, Yale University School of Medicine, New Haven, Connecticut
Ahmed Zidouh
Affiliation:
Departments of Medicine (Infectious Diseases) and Epidemiology, Yale University School of Medicine, New Haven, Connecticut
Peggy Miniter
Affiliation:
Departments of Medicine (Infectious Diseases) and Epidemiology, Yale University School of Medicine, New Haven, Connecticut
Vincent T. Andriole
Affiliation:
Departments of Medicine (Infectious Diseases) and Epidemiology, Yale University School of Medicine, New Haven, Connecticut
Thomas F. Patterson
Affiliation:
Departments of Medicine (Infectious Diseases) and Epidemiology, Yale University School of Medicine, New Haven, Connecticut
*
The University of Texas Health Science Center at San Antonio, Department of Medicine, Division of Infectious Diseases, 7703 Floyd Curl Dr, San Antonio, TX 78284-7881
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To monitor the epidemiology of invasive aspergillosis at a university hospital during a period of hospital construction. To compare the efficacy of active epidemiologic surveillance for invasive aspergillosis using Aspergillus cultures with the efficacy of surveillance using Aspergillus antigen detection.

Design:

A prospective surveillance study.

Setting:

An 850-bed, tertiary-care, university-based hospital.

Patients:

A convenience sample of 153 patients with Aspergillus antigen testing and culture.

Results:

24 cases were identified over a 12-month period; 7 were nosocomial, and 17 were community-acquired. Cases occurred primarily in patients with hematologic malignancy, but also occurred in patients with solid tumor, steroid treatment, cardiac transplant, and acquired immunodeficiency syndrome. Culture techniques identified only 14 (58%) of 24 cases, whereas Aspergillus antigen was positive in 19 (79%) of 24 cases tested. Epidemiological surveillance using either antigen or culture positivity detected 22 (92%) of 24 cases. In addition, antigen detection was 98% specific for the detection of aspergillosis, as compared to 91% for culture and 88% for antigen and culture combined.

Conclusions:

Hospital surveillance for aspergillosis should include determination of whether cases are nosocomial or community-acquired, because many may be the latter. Patients at risk for aspergillosis include patients without hematologic malignancies. Enhanced case detection occurred with active surveillance of patients considered to be at risk using both fungal serology and traditional microbiological techniques. Antigen detection was more sensitive and specific for the detection of invasive aspergillosis and may improve epidemiological surveillance for aspergillosis.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 2 , February 1997 , pp. 104 - 108
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Rhame, FS. Nosocomial aspergillosis: how much protection for which patients? Infect Control Hosp Epidemiol 1989;10:296–298.Google Scholar
2. Walsh, TJ, Dixon, DM. Nosocomial aspergillosis: environmental microbiology, hospital epidemiology, diagnosis and treatment. Eur J Epidemiol 1989;5:131–142.CrossRefGoogle ScholarPubMed
3. Weems, JJ, Davis, BJ, Tablan, OC, Kaufman, L, Martone, WJ. Construction activity: an independent risk factor for invasive aspergillosis and zygomycosis in patients with hematologic malignancy. Infect Control 1987;8:71–75.CrossRefGoogle ScholarPubMed
4. Sarubbi, FA Jr, Kopf, HB, Wilson, MB, McGinnis, MR, Rutala, WA. Increased recovery of Aspergillus flavus from respiratory specimens during hospital construction. Am Rev Respir Dis 1982;1125:33–38.Google Scholar
5. Klimowski, LL, Rotstein, C, Cummings, KM. Incidence of noso-comial aspergillosis in patients with leukemia over a twenty-year period. Infect Control Hosp Epidemiol 1989;10:299–305.CrossRefGoogle Scholar
6. Arnow, PM, Sadigh, M, Costas, C, Weil, D, Chudy, R. Endemic and epidemic aspergillosis associated with in-hospital replication of Aspergillus organisms. J Infect Dis 1991;164:998–1002.Google Scholar
7. McWhinney, PHM, Kibbler, CC, Hamon, MD, et al. Progress in the diagnosis and management of aspergillosis in bone marrow transplantation: 13 years' experience. Clin Infect Dis 1993; 17:397–404.CrossRefGoogle ScholarPubMed
8. Iwen, PC, Reed, EC, Armitage, JO, et al. Nosocomial invasive aspergillosis in lymphoma patients treated with bone marrow or peripheral stem cell transplants. Infect Control Hosp Epidemiol 1993;14:131–139.Google Scholar
9. Peterson, PK, McGlave, P, Ramsay, NKC, et al. A prospective study of infectious diseases following bone marrow transplantation: emergence of Aspergillus and Cytomegalovirus as the major causes of mortality. Infect Control 1983;4:81–89.Google Scholar
10. Patterson, TF, Miniter, P, Patterson, JE, Rappeport, JM, Andriole, VT. Aspergillus antigen detection in the diagnosis of invasive aspergillosis. J Infect Dis 1995;171:1553–1558.CrossRefGoogle ScholarPubMed
11. Sabetta, JR, Miniter, P, Andriole, VT. The diagnosis of invasive aspergillosis by an enzyme-linked immunosorbent assay for circulating antigen. J Infect Dis 1985;152:946–953.Google Scholar
12. Opal, SM, Asp, AA, Cannady, PB Jr, Morse, PL, Burton, LJ, Hammer, PG. Efficacy of infection control measures during a nosocomial outbreak of disseminated aspergillosis associated with hospital construction. J Infect Dis 1986;153:634–637.Google Scholar
13. Denning, DW, Stevens, DA. The treatment of invasive aspergillosis: surgery and antifungal therapy of 2,121 published cases. Rev Infect Dis 1990;12:1147–1201.Google Scholar
14. Kramer, MN. Nosocomial aspergillosis in lymphoma patients. Infect Control Hosp Epidemiol 1993;14:509. LetterGoogle Scholar
15. Sherertz, RJ, Belani, A, Kramer, BS, et al. Impact of air filtration on nosocomial Aspergillus infections. Unique risk of bone marrow transplant recipients. Am J Med 1987;83:709–718.Google Scholar
16. Rogers, TR. Prevention of infection in neutropenic bone marrow transplant patients. Antibiot Chemother 1985;3:90–113.Google Scholar
17. Marier, R, Smith, W, Jansen, M, Andriole, VT. A solid-phase radioimmunoassay for the measurement of antibody to Aspergillus in invasive aspergillosis. J Infect Dis 1979;140:771–779.CrossRefGoogle ScholarPubMed