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Open Access Highly Accessed Research article

Five-years surveillance of invasive aspergillosis in a university hospital

Karolin Graf1*, Somayeh Mohammad Khani1, Ella Ott1, Frauke Mattner12, Petra Gastmeier13, Dorith Sohr3, Stefan Ziesing1 and Iris F Chaberny1

Author Affiliations

1 Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany

2 Institute for Hygiene, University Hospital Witten-Herdecke, Campus Köln-Merheim, Germany

3 Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Germany

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BMC Infectious Diseases 2011, 11:163  doi:10.1186/1471-2334-11-163

Published: 8 June 2011

Abstract

Background

As the most common invasive fungal infection, invasive aspergillosis (IA) remains a serious complication in immunocompromised patients, leading to increased mortality. Antifungal therapy is expensive and may result in severe adverse effects.

The aim of this study was to determine the incidence of invasive aspergillosis (IA) cases in a tertiary care university hospital using a standardized surveillance method.

Methods

All inpatients at our facility were screened for presence of the following parameters: positive microbiological culture, pathologist's diagnosis and antifungal treatment as reported by the hospital pharmacy. Patients fulfilling one or more of these indicators were further reviewed and, if appropriate, classified according to international consensus criteria (EORTC).

Results

704 patients were positive for at least one of the indicators mentioned above. Applying the EORTC criteria, 214 IA cases were detected, of which 56 were proven, 25 probable and 133 possible. 44 of the 81 (54%) proven and probable cases were considered health-care associated. 37 of the proven/probable IA cases had received solid organ transplantation, an additional 8 had undergone stem cell transplantation, and 10 patients were suffering from some type of malignancy. All the other patients in this group were also suffering from severe organic diseases, required long treatment and experienced several clinical complications. 7 of the 56 proven cases would have been missed without autopsy. After the antimycotic prophylaxis regimen was altered, we noticed a significant decrease (p = 0.0004) of IA during the investigation period (2003-2007).

Conclusion

Solid organ and stem cell transplantation remain important risk factors for IA, but several other types of immunosuppression should also be kept in mind. Clinical diagnosis of IA may be difficult (in this study 13% of all proven cases were diagnosed by autopsy only). Thus, we confirm the importance of IA surveillance in all high-risk patients.

Keywords:
surveillance; invasive Aspergillosis; epidemiology; pathology