Hospital-wide prospective mandatory surveillance of invasive aspergillosis in a French teaching hospital (2000–2002)

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Summary

A multidisciplinary working group devoted to epidemiological surveillance of invasive aspergillosis (IA) was created in January 2000 in Grenoble University Hospital. This article presents the results of a three-year IA surveillance. The multidisciplinary working group surveyed all hospitalized patients, and the mycology laboratory detected most suspected IA cases. Cases were reviewed monthly by the Aspergillosis Committee, and were classified according to international consensus criteria. Possible nosocomial acquisition was determined. Among the 490 alerts, 74 IA cases were observed: six proven cases (8%), 36 (49%) probable cases and 32 (43%) possible cases. The incidence was 4.4 (95% CI 3.4–5.4) IA/100 000 patient-days. Among the proven and probable IA cases, we observed 10 nosocomial cases and six cases of undetermined origin. No cases were noted in the protected rooms in the haematology unit. Only one cluster of cases (three nosocomial cases) was detected in the haematology unit. Forty-three percent of cases (N=32) were hospitalized in the haematology unit, and all other cases were hospitalized elsewhere. This three-year survey found a high rate of non-nosocomial IA cases and a high frequency of IA cases hospitalized in units other than haematology. Thus, this study shows the importance of IA surveillance in haematology units and all high-risk units.

Introduction

Invasive aspergillosis (IA) has emerged as a major infectious complication in immunocompromised patients.1, 2 Indeed, the number of patients with risk factors for IA is increasing with the development of new intensive chemotherapy regimens for solid or haematological malignancies and with the growing number of stem cell and solid organ transplantations. This infection is noteworthy because of its poor prognosis and the possibility of acquisition by inhalation of conidia present in the hospital environment.1 Critical periods of immunosuppression (agranulocytosis after chemotherapy or following transplantation) often coincide with the patient's hospital stay and, consequently, hospital acquisition is possible. Thus, outbreaks of nosocomial infection are recognized and have been attributed to factors such as ongoing construction and fire-proofing material.3, 4, 5 The Centers for Disease Control and Prevention (CDC) have established the need for epidemiological surveillance of pulmonary IA in hospitals.6 In France, two official guidelines concerning IA prevention recently recommended epidemiological surveillance of IA in hospitals. It is mandatory to report nosocomial IA cases to health authorities.7, 8 IA surveillance started in Grenoble University Hospital in January 2000. This article reports the results of a three-year surveillance.

Section snippets

Hospital settings

Grenoble University Hospital was built in 1972 and has 2005 beds, with specialized units such as haematology, intensive care, infectious diseases, respiratory, etc. Solid organ transplantations (lung, kidney, liver, heart) are performed in certain surgical and intensive care units. The hospital comprises one central building with an 85% opacimetric air filtration efficiency, and peripheral wings without any air filtration. All high-risk units (haematology, oncology, intensive care, infectious

Results

This epidemiological study was performed between January 2000 and December 2002. During this period, 490 clinical/radiological or mycological alerts were reported. Among these, 74 cases of IA were suspected after evaluation of risk factors: six (8%) cases were proven, 36 (49%) cases were probable, and 32 (43%) cases were possible.

Discussion

Epidemiological surveillance of IA is recommended by the CDC and the French Consensus Conference on IA Prevention, and is a French legal requirement.6, 7, 8 However, there is no standardization of epidemiological surveillance. Published data are difficult to analyse and compare for the following reasons. Firstly, there is heterogeneity of IA definitions in the literature. Before 2000, there were no consensual criteria for IA. In 2000, the EORTC established international criteria for the

Acknowledgements

We wish to thank all the physicians of Grenoble University Hospital and Dr A. Thabuis who contributed to the IA surveillance.

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