405. Geoclimatic Influences on Invasive Aspergillosis Following Hematopoietic Stem Cell Transplantation
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Invasive aspergillosis (IA) is associated with high mortality among those who undergo hematopoietic stem cell transplantation (HSCT). Environmental factors that influence risk require study to optimize prevention strategies.
Methods: IA case distribution was evaluated in two large cohorts of patients who received HSCT in geographically and climatically diverse regions (Seattle, WA and Houston, TX, USA) during 1992-2003. Medical records were examined to determine association with IA incidence using the Kaplan-Meier method and Cox proportional hazards regression, with the main endpoints being time until IA diagnosis within 3 months after HSCT. We also correlated IA monthly seasonal rates with environmental spore counts and climatologic variables using Poisson regression analysis.
Results: In Seattle, the overall cumulative incidence for IA within 3-months post-HSCT was 4.6% (5.7% allograft and 0.8% autograft recipients). HSCT during the warm, dry months (July - September) was associated with a significant increased hazard for IA (HR 1.87, 95% CI: 1.25 to 2.81) after controlling for potential confounders. We identified a non-linear seasonal trend for IA (p=0.02) that was positively correlated with environmental spore counts (p=0.006), increasing prominently with low precipitation (p=0.03) during the warm season. In Houston, IA incidence did not vary by season (p=0.41).
Conclusion: Climatic variables influence seasonal patterns of airborne spore counts and IA risk differentially in geographically dissimilar transplant centers. This finding should be considered when developing infection control measures and timely preventative approaches.
Michael Boeckh, MD, FIDSA1, Dimitrios Kontoyiannis, MD, ScD, FIDSA2, Hong Li, MD, MSPH3, Kieren A. Marr, MD, FIDSA4, Motomi Mori, PhD3, Anil Panackal, MD, ScM, FACP5, Cheryl Perego, MT(ASCP), MPH, CIC6 and  A. A. Panackal, None..
H. Li, None..
D. P. Kontoyiannis, None..
M. Mori, None..
C. A. Perego, None. 
M. Boeckh,
Roche Pharmaceuticals Role(s): Consultant, Research Relationship, Consultant, Research Relationship, Consultant, Research Relationship, Received: Research Support, Consulting Fee.
Vical Inc. Role(s): Research Relationship, Research Relationship, Research Relationship, Received: Research Support.
Viropharma Inc Role(s): Consultant, Research Relationship, Consultant, Research Relationship, Consultant, Research Relationship, Received: Research Support, Consulting Fee.
Novartis Role(s): Consultant, Consultant, Consultant, Received: Consulting Fee.
Teraclone Role(s): Consultant, Consultant, Consultant, Received: Consulting Fee.
Aicuris AG Role(s): Consultant, Consultant, Consultant, Received: Consulting Fee.
K. A. Marr, None., (1)Fred Hutchinson Cancer Research Center, Seattle, WA, (2)The University of Texas M.D. Anderson Cancer Center, Houston, TX, (3)Biostatistics and Design Program, Oregon Clinical and Translational Research Institute; Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health & Science University;, Portland, OR, (4)Medicine & Oncology, The Johns Hopkins Hospital, Baltimore, MD, (5)U.S. Department of State, Washington, DC, (6)University of Texas M.D. Anderson Cancer Center, Houston, TX

Disclosures:

M. Boeckh, None

D. Kontoyiannis, None

H. Li, None

K. A. Marr, None

M. Mori, None

A. Panackal, None

C. Perego, None