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The Epidemiology of Invasive Pulmonary Aspergillosis at a Large Teaching Hospital

Published online by Cambridge University Press:  02 January 2015

Clare F. Pegues ,
Eric S. Daar  and
A. Rekha Murthy
Clare F. Pegues
Affiliation:
Department of Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, California
Eric S. Daar
Affiliation:
Division of Infectious Diseases, Cedars-Sinai Medical Center, and the Division of Infectious Diseases, Cedars-Sinai Medical Center, Los Angeles, California
A. Rekha Murthy*
Affiliation:
Department of Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, California Division of Infectious Diseases, Cedars-Sinai Medical Center, and the Division of Infectious Diseases, Cedars-Sinai Medical Center, Los Angeles, California
*
Department of Hospital Epidemiology, Division of Infectious Diseases, MOT 1130 East, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048
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Abstract

Objective:

To characterize the epidemiology of invasive pulmonary aspergillosis (IPA).

Design:

A retrospective case series.

Setting:

An 850-bed, academic, tertiary-care medical center.

Participants:

Adult inpatients, between January 1, 1990, and December 31, 1998, with either a histopathology report consistent with IPA or a discharge diagnosis of aspergillosis.

Methods:

We reviewed medical records and categorized case-patients as definitive or probable and acquisition of IPA as nosocomial, indeterminate, or community using standard definitions. To determine the rate of aspergillus respiratory colonization, we identified all inpatients who had a respiratory culture positive for Aspergillus species without a histopathology report consistent with IPA or a discharge diagnosis of aspergillosis. Three study intervals were defined: interval 1,1990 to 1992; interval 2,1993 to 1995; and interval 3,1996 to 1998. Carpeting in rooms for patients following heart-lung and liver transplant was removed and ceiling tiles were replaced during interval 1; a major earthquake occurred during interval 2.

Results:

72 case-patients and 433 patients with respiratory colonization were identified. Acquisition was nosocomial for 18 (25.0%), indeterminate for 9 (12.5%), and community-acquired for 45 (62.5%) case-patients. Seventeen (23.6%) of the 72 case-patients had prior transplants, including 15 solid organ and 2 bone marrow. The IPA rate per 100 solid organ transplants (SOTs) decreased from 2.45 during interval 1 to 0.93 during interval 2 and to 0.52 during interval 3 (chi-square for trend, 5.44; P<.05). The hospitalwide IPA rate remained stable at 0.03 per 1,000 patient days.

Conclusions:

The SOT IPA rate decreased after intervals 1 and 2, although the hospitalwide IPA rate remained stable during the study period. Post-earthquake hospital demolition and construction occurring after interval 2 was not associated with an increase in the rate of IPA at our institution.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 6 , June 2001 , pp. 370 - 374
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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