622. Outbreak of Aspergillus fumigatus at a Hospital Undergoing Major Construction Arizona 2010
Session: Abstracts: Mycology
Friday, October 22, 2010
Background:

Aspergillus fumigatus is an environmental fungus that can cause life-threatening infections.  In December 2009, a cluster of patients with A. fumigatus was identified at a hospital undergoing major construction. We performed an investigation to determine risk factors for illness and look for an environmental source.

Methods:

A case-control study and an environmental investigation were conducted.  A case was defined as a hospitalized patient with an A. fumigatus isolate obtained > 48 hours after admission. Control subjects, matched to cases by age and gender, were ICU patients who underwent bronchoscopy during the same time period.  Patient characteristics and clinical data were compared by calculating matched odds ratios.  We sampled air and surfaces from the air handling system, ICU, and medical imaging area. Environmental samples were examined using selective culture media and quantitative PCR (qPCR). Molecular subtyping was performed on recovered clinical and environmental A fumigatus isolates.

Results:

Nine cases were identified. Median age was 58 years, 7 (78%) had an underlying lung condition, 100% had been in an ICU prior to the first positive culture, 6 (67%) were immunocompromised, and 6 (67%) died. Case status was associated with tobacco use (OR 9.8, CI 1.2- 466.3), COPD (OR 5.3, CI 0.9-57.2), immunocompromised state (OR 4.2 , CI 0.8-28.2), and death (OR  4.8, CI  0.9-31.7). No associations were identified with specific medical treatments, procedures, or imaging.  Four environmental samples yielded A fumigatus by culture; none were positive by qPCR.  Although direct comparison of qPCR and culture was not possible, we did find a lack of correlation between both methods.  Molecular subtyping of environmental isolates and five clinical isolates revealed two genotypically similar case isolates.  Environmental isolates were not genotypically related to clinical isolates.

Conclusion:

Intermittent A. fumigatus spore bursts during construction is the probable source. Molecular subtyping remains an important tool in hospital-associated Aspergillus outbreaks. The role of qPCR in outbreaks deserves further study.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Monika Roy, MD , Centers for Disease Control and Prevention, Atlanta, GA
Steven Baty, DVM , Arizona Department of Health Services, Phoenix, AZ
Aarikha D'Souza, MPH , Arizona Department of Health Services, Phoenix, AZ
Tammy Sylvester, RN , Maricopa County Department of Public Health, Phoenix, AZ
Kristen Korte, RN, CIC , Banner Thunderbird Medical Center, Glendale, AZ
Tammy Beahm, RN, BSN, CIC , Banner Thunderbird Medical Center, Glendale, AZ
Kari Bjornard, BS , Centers for Disease Control and Prevention, Atlanta, GA
Eszter Deak, PhD , Centers for Disease Control and Prevention, Atlanta, GA
Kizee Etienne, MPH , Centers for Disease Control and Prevention, Atlanta, GA
Tara Waybrant, MS , Centers for Disease Control and Prevention, Atlanta, GA
Rebecca Sunenshine, MD , Maricopa County Department of Public Health, Phoenix, AZ
Ken Komatsu, MPH , Arizona Department of Health Services, Phoenix, AZ
S. Arunmozhi Balajee, PhD , Centers for Disease Control and Prevention, Atlanta, GA
Tom Chiller, MD, MSTMH , Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

M. Roy, None

S. Baty, None

A. D'Souza, None

T. Sylvester, None

K. Korte, None

T. Beahm, None

K. Bjornard, None

E. Deak, None

K. Etienne, None

T. Waybrant, None

R. Sunenshine, None

K. Komatsu, None

S. A. Balajee, None

T. Chiller, None

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