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Filamentous Fungi in a Tertiary Care Hospital Environmental Surveillance and Susceptibility to Antifungal Drugs

Published online by Cambridge University Press:  02 January 2015

Paraskevi Panagopoulou ,
Joanna Filioti ,
Evangelia Farmaki ,
Avgi Maloukou  and
Emmanuel Roilides
Paraskevi Panagopoulou
Affiliation:
Third Department of Pediatrics, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
Joanna Filioti
Affiliation:
Third Department of Pediatrics, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
Evangelia Farmaki
Affiliation:
Third Department of Pediatrics, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
Avgi Maloukou
Affiliation:
Third Department of Pediatrics, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
Emmanuel Roilides
Affiliation:
Third Department of Pediatrics, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
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Abstract

Objective.

To evaluate filamentous fungi with respect to environmental load and potential drug resistance in a tertiary care teaching hospital.

Design.

Monthly survey in 2 buildings of the hospital during a 12-month period.

Setting.

Hippokration Hospital in Thessaloniki, Greece.

Methods.

Air, surface, and tap water sampling was performed in 4 departments with high-risk patients. As sampling sites, the solid-organ transplantation department and the hematology department (in the older building) and the pediatric oncology department and the pediatric intensive care unit (in the newer building) were selected.

Results.

From January to May of 2000, the fungal load in air (FLA) was low, ranging from 0 to 12 colony-forming units (cfu) per m3 in both buildings. During the summer months, when high temperature and humidity predominate, the FLA increased to 4-56 cfu/m3. The fungi commonly recovered from culture of air specimens were Aspergillus niger (25.9%), Aspergillus flavus (17.7%), and Aspergillus fumigatus (12.4%). Non-Aspergillus filamentous fungi, such as Zygomycetes and Dematiaceous species, were also recovered. The pediatric intensive care unit had the lowest mean FLA (7.7 cfu/m3), compared with the pediatric oncology department (8.7 cfu/m3), the solid-organ transplantation department (16.1 cfu/m3), and the hematology department (22.6 cfu/m3). Environmental surfaces were swabbed, and 62.7% of the swab samples cultured yielded filamentous fungi similar to the fungi recovered from air but with low numbers of colony-forming units. Despite vigorous sampling, culture of tap water yielded no fungi. The increase in FLA observed during the summer coincided with renovation in the building that housed the solid-organ transplantation and hematology departments. All 54 Aspergillus air isolates randomly selected exhibited relatively low minimum inhibitory or effective concentrations for amphotericin B, itraconazole, voriconazole, posaconazole, micafungin, and anidulafungin.

Conclusion.

Air and surface fungal loads may vary in different departments of the same hospital, especially during months when the temperature and humidity are high. Environmental Aspergillus isolates are characterized by lack of resistance to clinically important antifungal agents.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 1 , January 2007 , pp. 60 - 67
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1. Clark, TA, Hajjeh, RA. Recent trends in the epidemiology of invasive mycoses. Curr Opin Infect Dis 2002;15:569–574.Google Scholar
2. Denning, DW. Invasive aspergillosis. Clin Infect Dis 1998;26:781–803.CrossRefGoogle ScholarPubMed
3. Martino, R, Subira, M. Invasive fungal infections in hematology: new trends. Ann Hematol 2002;81:233–243.Google Scholar
4. Marr, KA, Carter, RA, Crippa, F, Wald, A, Corey, L. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis 2002;34:909–917.Google Scholar
5. Winkelstein, JA, Marino, MC, Johnston, RB, et al. Chronic granulomatous disease: report on a national registry of 368 patients. Medicine (Baltimore) 2000;79:155–169.CrossRefGoogle Scholar
6. De Rosa, FG, Shaz, D, Campagna, AC, Dellaripa, PE, Khettry, U, Craven, DE. Invasive pulmonary aspergillosis soon after therapy with infliximab, a tumor necrosis factor-alpha-neutralizing antibody: a possible healthcare-associated case? Infect Control Hosp Epidemiol 2003;24:477–482.CrossRefGoogle ScholarPubMed
7. Latge, JP. Aspergillus fumigatus and aspergillosis. Clin Microbiol Rev 1999;12:310–350.CrossRefGoogle ScholarPubMed
8. Ibrahim-Granet, O, Philippe, B, Boleti, H, et al. Phagocytosis and intracellular fate of Aspergillus fumigatus conidia in alveolar macrophages. Infect Immun 2003;71:891–903.Google Scholar
9. Roilides, E, Meletiadis, J. Role of cytokines against invasive aspergillosis: evidence from in vitro studies. Rev Med Microbiol 2003;14:63–72.Google Scholar
10. Menotti, J, Waller, J, Meunier О, Letscher-Bru, V, Herbrecht, R, Candolfi, E. Epidemiological study of invasive pulmonary aspergillosis in a hae-matology unit by molecular typing of environmental and patient isolates of Aspergillus fumigatus . J Hosp Infect 2005;60:61–68.CrossRefGoogle Scholar
11. Boucher, HW, Groll, AH, Chiou, CC, Walsh, TJ. Newer systemic antifungal agents: pharmacokinetics, safety and efficacy. Drugs 2004;64:1997–2020.Google Scholar
12. National Committee for Clinical Laboratory Standards (NCCLS). Reference Method for Broth Dilution Antifungal Susceptibility Testing of Conidium-Forming Filamentous Fungi: Approved Standard M38-A. Wayne, PA: NCCLS; 2002.Google Scholar
13. Guinea, J, Pelaez, T, Alcala, L, Ruiz-Serrano, MJ, Bouza, E. Antifungal susceptibility of 596 Aspergillus fumigatus strains isolated from outdoor air, hospital air, and clinical samples: analysis by site of isolation. An-timicrob Agents Chemother 2005;49:3495–3497.CrossRefGoogle ScholarPubMed
14. Arikan, S, Lozano-Chiu, M, Paetznick, V, Rex, JH. In vitro susceptibility testing methods for caspofungin against Aspergillus and Fusarium isolates. Antimicrob Agents Chemother 2001;45:327–330.Google Scholar
15. Ascioglu, S, Rex, JH, de Pauw, B, et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 2002;34:7–14.Google Scholar
16. Rhame, FS. Prevention of nosocomial aspergillosis. J Hosp Infect 1991;18(Suppl A): 466–472.Google Scholar
17. Morris, G, Kokki, MH, Anderson, K, Richardson, MD. Sampling of Aspergillus spores in air. J Hosp Infect 2000;44:81–92.CrossRefGoogle ScholarPubMed
18. Goodley, JM, Clayton, YM, Hay, RJ. Environmental sampling for aspergini during building construction on a hospital site. J Hosp Infect 1994;26:27–35.Google Scholar
19. Curtis, L, Cali, S, Conroy, L, et al. Aspergillus surveillance project at a large tertiary-care hospital. J Hosp Infect 2005;59:188–196.Google Scholar
20. Rath, PM, Ansorg, R. Value of environmental sampling and molecular typing of aspergilli to assess nosocomial sources of aspergillosis. J Hosp Infect 1997;37:47–53.Google Scholar
21. Kennedy, HF, Michie, JR, Richardson, MD. Air sampling for Aspergillus spp. during building activity in a paediatric hospital ward. J Hosp Infect 1995;31:322–325.Google Scholar
22. Munoz, P, Burlilo, A, Bouza, E. Environmental surveillance and other control measures in the prevention of nosocomial fungal infections. Clin Microbiol Infect 2001;7(Suppl 2):38–45.Google Scholar
23. Bouza, E, Pelaez, T, Perez-Molina, J, et al. Demolition of a hospital building by controlled explosion the impact of filamentous fungal load in internal and external air. J Hosp Infect 2002;52:234–242.CrossRefGoogle ScholarPubMed
24. Centers for Disease Control and Prevention. Guideline for prevention of nosocomial pneumonia. MMWR Recomm Rep 1997;46(RR-1):1–79.Google Scholar
25. Panagopoulou, P, Filioti, J, Petrikkos, G, et al. Environmental surveillance of filamentous fungi in three tertiary care hospitals in Greece. J Hosp Infect 2002;52:185–191.Google Scholar
26. Warris, A, Gaustad, P, Meis, JF, et al. Recovery of filamentous fungi from water in a paedriatic bone marrow transplantation unit. J Hosp Infect 2001;47:143–148.Google Scholar
27. Arvanitidou, M, Kanellou, K, Constantinides, TC, et al. The occurrence of fungi in hospital and community potable waters. Lett Appi Microbiol 1999;29:81–84.Google Scholar
28. Arvanitidou, M, Spaia, S, Velegraki, A, et al. High level of recovery of fungi from water and dialysate in haemodialysis units. J Hosp Infect 2000;45:225–230.Google Scholar
29. Warris, A, Voss, A, Abrahamsen, TG, Verweij, PE. Contamination of hospital water with Aspergillus fumigatus and other molds. Clin Infect Dis 2002;34:1159–1160.CrossRefGoogle ScholarPubMed
30. Gangneux, JP, Bretagne, S, Cordonnier C, et al. Prevention of nosocomial fungal infection: the French approach. Clin Infect Dis 2002;35:343–346.Google Scholar
31. Anaissie, EJ, Kuchar, RT, Rex, JH, et al. Fusariosis associated with pathogenic Fusarium species colonization of a hospital water system: a new paradigm for the epidemiology of opportunistic mold infections. Clin Infect Dis 2001;33:1871–1878.Google Scholar
32. Anaissie, EJ, Stratton, SL, Dignani, MC, et al. Pathogenic Aspergillus species recovered from a hospital water system: a 3-year prospective study. Clin Infect Dis 2002;34:780–789.Google Scholar
33. Hospenthal, DR, Kwon-Chung, KJ, Bennet, JE. Concentrations of airborne Aspergillus compared to the incidence of invasive aspergillosis: lack of correlation. Med Mycol 1998;36:165–168.Google Scholar
34. Leenders, AC, van Belkum, A, Behrendt, M, Luijendijk, A, Verbrugh, HA. Density and molecular epidemiology of Aspergillus in air and relationship to outbreaks of Aspergillus infection. J Clin Microbiol 1999;37:1752–1757.Google Scholar
35. Sanglard, D, Odds, FC. Resistance of Candida species to antifungal agents: molecular mechanisms and clinical consequences. Lancet Infect Dis 2002;2:73–85.Google Scholar
36. Moore, CB, Sayers, N, Mosquera, J, Slaven, J, Denning, DW. Antifungal drug resistance in Aspergillus . J Infect 2000;41:203–220.Google Scholar
37. Kontoyiannis, DP, Lewis, RE. Antifungal drug resistance of pathogenic fungi. Lancet 2002;359:1135–1144.Google Scholar
38. Dannaoui, E, Borei, E, Monier, MF, Piens, MA, Picot, S, Persat, F. Acquired itraconazole resistance in Aspergillus fumigatus . J Antimicrob Chemother 2001;47:333–340.Google Scholar
39. Pfaller, MA, Marco, F, Messer, SA, Jones, RN. In vitro activity of two echinocandin derivatives, LY303366 and MK-0991 (L-743,792), against clinical isolates of Aspergillus, Fusarium, Rhizopus and other filamentous fungi. Diagn Microbiol Infect Dis 1998;30:251–255.CrossRefGoogle ScholarPubMed
40. Manavathu, EK, Cutright, JL, Loebenberg, D, Chandrasekar, PH. A comparative study of the in vitro susceptibilities of clinical and laboratory-selected resistant isolates of Aspergillus spp. to amphotericin B, itraconazole, voriconazole and posaconazole (SCH 56592). J Antimicrob Chemother 2000;46:229–234.Google Scholar
41. Espinel-Ingroff, A. In vitro antifungal activities of anidulafungin and micafungin, licensed agents and the investigational triazole posaconazole as determined by NCCLS methods for 12,052 fungal isolates: review of the literature. Rev Iberoam Micol 2003;20:121–136.Google Scholar
42. Verhoeff, AP, van Wijnen, JH, Boleij, JS, Brunekreef, B, van Reenen-Hoek-stra, ES, Samson, RA. Enumeration and identification of airborne viable mold propagules in houses: a field comparison of selected techniques. Allergy 1990;45:275–284.Google Scholar
43. Smid, T, Schokkin, E, Boleij, JS, Heederik, D. Enumeration of viable fungi in occupational environments: a comparison of samplers and media. Am Ind Hyg Assoc J 1989;50:235–239.CrossRefGoogle ScholarPubMed
44. Benbough, JE, Bennett, AM, Parks, SR. Determination of the collection efficiency of a microbial sampler. J Appi Bacteriol 1993;74:170–173.Google Scholar