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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
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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

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