Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-12-01T00:05:53.608Z Has data issue: false hasContentIssue false
  • English
  • Français

Interaction of Granulocytopenia and Construction Activity as Risk Factors for Nosocomial Invasive Filamentous Fungal Disease in Patients With Hematologic Disorders

Published online by Cambridge University Press:  21 June 2016

Stephen F. Weber ,
James E. Peacock Jr. ,
Kim-Anh Do ,
Julia M. Cruz ,
Bayard L. Powell  and
Robert L. Capizzi
Stephen F. Weber
Affiliation:
Sections on Infectious Disease, Winston-Salem, North Carolina
James E. Peacock Jr.*
Affiliation:
Sections on Infectious Disease, Winston-Salem, North Carolina
Kim-Anh Do
Affiliation:
Hematology-Oncology and Prevention Research and Biometry, Winston-Salem, North Carolina
Julia M. Cruz
Affiliation:
Cancer Center of Wake Forest University, Winston-Salem, North Carolina
Bayard L. Powell
Affiliation:
Cancer Center of Wake Forest University, Winston-Salem, North Carolina
Robert L. Capizzi
Affiliation:
Cancer Center of Wake Forest University, Winston-Salem, North Carolina
*
Department of Internal Medicine, Wake-Forest University Medical Center, 300 S. Hawthorne Rd., Winston-Salem, NC 27103
Get access Rights & Permissions [Opens in a new window]

Abstract

A clinicoepidemiologic study was undertaken to investigate an apparent increase in frequency of nosocomial invasive filamentous fungal disease (NIFFD) in adult patients with acute leukemia hospitalized during a period of hospital construction, and to determine if a relationship existed between the construction activity and the acquisition of NIFFD.

The first study goal, to determine the incidence of NIFFD before and during construction, was approached by calculation of incidence rates of NIFFD in patients with acute leukemia, comparing 1982 and 1983 (a baseline period free of construction) to 1986 (a year when construction activity was at its peak). The second study goal, to identify risk factors for the development of NIFFD, was accomplished by reviewing the autopsy records of all patients with underlying hematologic disorders accompanied by granulocytopenia who died in our hospital from 1982 through 1986. Patients with and without autopsy evidence of NIFFD were then compared by univariate and multivariate (logistic regression) analysis to identify potential risk factors for the acquisition of NIFFD.

The incidence of NIFFD in patients with acute leukemia hospitalized during the period of hospital construction was significantly increased when compared to a baseline period without construction (11 per 139 versus 4 per 333, p < .001). Review of all granulocytopenic patients autopsied over the five-year interval 1982 through 1986 revealed duration of granulocytopenia and hospitalization during construction to be risk factors for NIFFD by univariate analysis (p < .005). Logistic regression showed duration of granulocytopenia to be a highly significant independent risk factor (p < .01) and construction activity to be a probable independent risk factor (p = .09). The effect of construction on risk of NIFFD was most striking in those patients granulocytopenic for less than 40 days. The increased incidence of NIFFD occurred despite anticipation of this potential problem and compliance with published recommendations for infection control during periods of hospital construction.

Given the potentiating effect of construction activity on the occurrence of NIFFD in granulocytopenic patients and the suboptimal impact of standard recommended preventive measures, additional risk-reduction methods (i.e., surveillance culturing, prophylactic antifungal therapy, use of portable high efficiency particulate air filters) may be appropriate for patients expected to experience prolonged granulocytopenia (> 14 days) while hospitalized during periods of major construction activity involving excavation. Further studies will be necessary to define the roles of each of these modalities.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 11 , Issue 5 , May 1990 , pp. 235 - 242
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1990

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. Young, RC, Bennet, JE, Vogel, CL, Carbone, PP, DeVita, VT Aspergillosis: the spectrum of disease in 98 patients. Medicine. 1970;49:147–173.10.1097/00005792-197003000-00002Google Scholar
2. Fisher, BD, Armstrong, D, Yu, B, Gold, JWM. Invasive aspergillosis: progress in early diagnosis and treatment. Am J Med. 1981;71:571–577.10.1016/0002-9343(81)90208-4CrossRefGoogle ScholarPubMed
3. Winston, DJ, Gale, RP, Meyer, DV, Young, LS. Infectious complications of human bone marrow transplantation. Medicine. 1979;58:1–31.10.1097/00005792-197901000-00001Google Scholar
4. 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;4:81–89.10.1017/S0195941700057805Google Scholar
5. Rotstein, C, Cummings, KM, Tidings, J, et al. An outbreak of invasive aspergillosis among allogeneic bone marrow transplants: a case-control study. Infect Control. 1985;6:347–355.10.1017/S019594170006330XGoogle Scholar
6. 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;83:709–718.10.1016/0002-9343(87)90902-8CrossRefGoogle ScholarPubMed
7. Burton, JR, Zachery, JB, Bessin, R, et al. Aspergillosis in four renal transplant patients: diagnosis and effective treatment with amphotericin B. Ann Intern Med. 1972;77:383–388.10.7326/0003-4819-77-3-383Google Scholar
8. Kvrialddes, GK. Zinneman, HH. Hall, WH. et al. Immunologe monitoring and aspergillosis in renal transplant patients. Am J Surg. 1976;131:246–252.Google Scholar
9. Arnow, PM, Anderson, RL, Mainous, PD, Smith, EJ. Pulmonary aspergillosis during hospital renovation. Am Rev Respir Dis. 1978;118:49–53.Google Scholar
10. Lentino, JR, Rosenkranz, MA, Michael, JA, Kump, VP, Rose, HD, Rytel, MW. Nosocomial aspergillosis: a retrospective review of airborne disease secondary to road construction and contaminated air conditioners. Am J Epidemiol. 1982;116:430–437.10.1093/oxfordjournals.aje.a113427Google Scholar
11. Weiland, D, Ferguson, RM, Peterson, PK, Snover, DC, Simmons, RL, Najarian, JS. Aspergillosis in 25 renal transplant patients. Ann Surg. 1983;198:622–629.10.1097/00000658-198311000-00011CrossRefGoogle ScholarPubMed
12. Gustafson, TL, Schaffner, W, Lavely, GB, Stratton, CW, Johnson, HK, Hutcheson, RH. Invasive aspergillosis in renal transplant patients: correlation with corticosteroid therapy. J Infect Dis. 1983;148:230–238.10.1093/infdis/148.2.230CrossRefGoogle ScholarPubMed
13. Gurwith, MJ, Stinson, EB, Remington, JS. Aspergillus infection complicating cardiac transplantation. Arch Intern Med. 1971;128:541–545.10.1001/archinte.1971.00310220049004Google Scholar
14. Hofflin, JM, Potasman, I, Baldwin, JC, Oyer, PE, Stinson, EB, Remington, JS. Infectious complications in heart transplant recipients receiving cyclosporine and corticosteroids. Ann Intern Med. 1987;106:209–216.10.7326/0003-4819-106-2-209Google Scholar
15. Schroter, GPJ, Hoelscher, M, Putnam, CW, Porter, KA, Starzl, TE. Fungal infections after liver transplantation. Ann Surs. 1977;186:115–122.10.1097/00000658-197707000-00017CrossRefGoogle ScholarPubMed
16. Wood, RP, Shaw, BW, Starzl, TE. Extrahepatic complications of liver transplantation. Semin Liver Dis. 1985;5:377–384.10.1055/s-2008-1040636Google Scholar
17. Grenvik, A, Gordon, R. Postoperative care and problems in liver transplantation. Transplant Proc. 1987;19(suppl 3):26–33.Google ScholarPubMed
18. Stone, HH, Cuzzell, JZ, Kolb, LD, Moskowitz, MS, McGowan, JE. Aspergillus infection of the burn wound. J Trauma. 1979;19:765–767.10.1097/00005373-197910000-00008CrossRefGoogle ScholarPubMed
19. Rose, HD. Mechanical control of hospital ventilation and Aspergillus infections. Am Reu Respir Dis. 1972;105:306–307.Google Scholar
20. Meyer, RD, Young, LS, Armstrong, D, Yu, B. Aspergillosis complicating neoplastic disease. Am J Med. 1973;54:6–15.10.1016/0002-9343(73)90077-6Google Scholar
21. Aisner, J, Schimpff, SC, Bennett, JE, Young, VM, Wiernick, PH. infections in cancer patients: association with fireproofing materials in a new hospital. JAMA. 1976;235:411–412.10.1001/jama.1976.03260300037029Google Scholar
22. Mahoney, DH, Steuber, CP, Starling, KA, Barrett, FF, Goldberg, J, Fernbach, DJ. An outbreak of aspergillosis in children with acute leukemia. J Pediatr. 1979;95:70–72.10.1016/S0022-3476(79)80086-4Google Scholar
23. Aisner, J, Murillo, J, Schimpff, SC, Steere, AC. Invasive aspergillosis in acute leukemia: correlation with nose cultures and antibiotic use. Ann Intern Med. 1979;90:4–9.10.7326/0003-4819-90-1-4Google Scholar
24. Gerson, SL, Talbot, GH, Hurwitz, S, Strom, BL, Lusk, EJ, Cassileth, PA. Prolonged granulocytopenia: the major risk factor for invasive pulmonary aspergillosis in patients with acute leukemia. Ann Intern Med. 1984;100:345–351.10.7326/0003-4819-100-3-345Google Scholar
25. Opal, SM, Asp, AA, Cannady, PB, Morse, PI, Burton, LJ, Hammer, PG. Efficacy of infection control measures during a nosocomial outbreak of disseminated aspergillosis associated with hospital construction. J Infect Dis. 1986;153:634–637.10.1093/infdis/153.3.634Google Scholar
26. Allo, MD, Miller, J, Townsend, T, Tan, C. Primary cutaneous aspergillosis associated with Hickman intravenous catheters. N Engl J Med. 1987;317:1105–1108.10.1056/NEJM198710293171802Google Scholar
27. 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;8:71–75.10.1017/S0195941700067114CrossRefGoogle ScholarPubMed
28. Corrado, ML, Cleri, D, Fikrig, SM, Phillips, JC. Aspergillosis in chronic granulomatous disease: therapeutic considerations. Am J Dis Child. 1980;134:1092–1094.Google Scholar
29. Cohen, MS, Isturiz, RE, Malech, HL, et al. Fungal infection in chronic disease. The importance of the phagocyte in defense against fungi. Am J Med. 1981;71:59–66.10.1016/0002-9343(81)90259-XCrossRefGoogle ScholarPubMed
30. Levitz, SM, Diamond, RD. Changing patterns of aspergillosis infections. Adu Intern Med. 1984;30:153–174.Google Scholar
31. Karam, GH, Griffin, FM. Invasive pulmonary aspergillosis in nonim-munocompromised, non-granulocytopenic hosts. Rev Infect Dis. 1985;8:357–363.10.1093/clinids/8.3.357CrossRefGoogle Scholar
32. Krasmski, K, Holzman, RS, Hanna, B, Greco, MA, Graff, M, Bhogal, M. Nosocomial fungal infection during hospital renovation. Infect Control 1985;6:278–282.10.1017/S0195941700061750Google Scholar
33. Rhame, FS, Streifel, AJ, Kersey, JH, McGlave, PB. Extrinsic risk factors for pneumonia in the patient at high risk of infection. Am J Med. 1984;76(suppl 5A):42–52.10.1016/0002-9343(84)90243-2Google Scholar
34. Gage, AA, Dean, DC, Schimert, G, Minsley, N. Aspergillus infection after cardiac surgery. Arch Surg. 1970;101:384–387.10.1001/archsurg.1970.01340270032009Google Scholar
35. England, AC, Weinstein, M, Ellner, JJ, Ajello, L. Two cases of rhinocerebral zygomycosis (mucormycosis) with common epidemiologic and environmental features. Am Rev Respir Dis. 1981;124:497–498.Google Scholar
36. Sarubbi, FA, Kopf, HB, Wilson, BJ, McGmnis, MR, Rutala, WA. Increased recovery of Aspergillus flauusfrom respiratory specimens during hospital construction. Am Rev Respir Dis. 1982;125:33–38.Google Scholar
37. Hernanz, AP, Fereres, J, Garrous, SL, Rodriguez-Noriega, A, Sanz, AS. Nosocomial infection by Rhizomucor pusillus in a clinical haemotology unit. J Hosp Infect. 1983;4:45–49.10.1016/0195-6701(83)90064-6CrossRefGoogle Scholar
38. Rubin, RH. The compromised host as sentinel chicken. N Engl J Med. 1987;317:1151–1152.10.1056/NEJM198710293171809CrossRefGoogle ScholarPubMed
39. Walsh, TJ, Pizzo, PA. Nosocomial fungal infections: a classification for hospital-acquired fungal infections and mycoses arising from endogenous flora or reactivation. Annu Rev Microbiol. 1988;42:517–545.10.1146/annurev.mi.42.100188.002505Google Scholar
40. Weber, DJ, Rutala, WA. Epidemiology of hospital-acquired fungal infections. In: Holmberg, K, Meyer, R, eds. Diagnosis and Therapy of Systemic Fungal Infections. New York, NY; Raven Press, Ltd; 1989:124.Google Scholar
41. Anaissie, E, Kantajian, H, Ro, J, et al. The emerging role of Fusarium infections in patients with cancer. Medicine. 1988;67:77–83.10.1097/00005792-198803000-00001Google Scholar
42. Meunier, F, Leleux, A, Gerain, J, Ninove, D, Snoeck, R, Klastersky, J. Prophylaxis of aspergillosis in neutropenic cancer patients with nasal spray of amphotericin B: a prospective randomized study (abstract). Proceedings of the Twenty-Seventh Interscience Conference on Antimicrobial Agents and Chemotherapy. New York, NY: American Society for Microbiology; 1987:331.Google Scholar
43. Schmitt, HJ, Bernard, EM, Hauser, M, Armstrong, D. Aerosol amphotericin B is effective for prophylaxis and therapy in a rat model of pulmonary aspergillosis. Antimicrob Agents Chemother. 1988;32:1676–1679.10.1128/AAC.32.11.1676Google Scholar
44. Drouhet, E. Dupont, B. Evolution of anitfungal agents: past, present, and future. Rev Infect Dis. 1987;9(suppl 1):S4–S14.10.1093/clinids/9.Supplement_1.S4Google Scholar
45. Norris, SM. Amphotericin-how safe and effective? Infect Control. 1985;6:243–245.10.1017/S0195941700061622Google Scholar
46. Tricot, G, Joosten, E, Boogaerts, MA, Vande Pitte, J, Cauwenbergh, G. Ketoconazole vs itraconazole for antifungal prophylaxis in patients with severe granulocytopenia: preliminary results of two nonrandomized studies. Rev Infect Dis. 1987;9(suppl 1):S94–S99.Google Scholar
47. Merz, WG, Karp, JE, Saral, R. Lack of correlation of nares culture results and invasive aspergillosis in compromised patients (abstract). Abstracts Annual Meeting. Am Soc Microbiol. 1987;87:176.Google Scholar
48. Yu, VL, Muder, RR, Poorsattar, A. Significance of isolation of Aspergillus from the respiratory tract in diagnosis of invasive pulmonary aspergillus: results from a three-year prospective study. Am J Med. 1986;81:249–254.10.1016/0002-9343(86)90259-7CrossRefGoogle ScholarPubMed