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在意大利举办的“3rd TIMM”会议，主要是关于真菌感染的诊断和治疗，也有部分涉及预防的内容。其中有研究指出，空气和水，是医院内曲霉菌感染的重要来源。
M10
Hospitals outbreaks of invasive mould infections: controlling the air and water
acquisition
A. Warris1, M. Richardson 2
1Radboud University Nijmegen Medical Center, Nijmegen University Center of
Infectious Diseases, Nijmegen, The Netherlands 2Helsinki University Central
Hospital, University of Helsinki, Finland
Invasive mould infections present a formidable problem in terms of diagnosis, and
even more so in terms of therapy. The outcome is often fatal and prevention
measures are of major importance in the control of invasive mould infections.
Molecular investigations to determine the source in case of an increase in number of
invasive mould infections or even outbreaks are hampered by the huge genetic
diversity of these micro-organisms. Invasive aspergillosis is the most frequent
invasive mould infection encountered, and therefore most studies have been
focussed on this mould. We would argue strongly that it is of paramount importance
to monitor the hospital environment for the presence of contamination with moulds on
a regular, prospective basis. In particular, those areas were patients at risk for
invasive mould infectious are cared for such as haemato-oncology wards and
isolation rooms for SCT-patients and immunocompromised patients. Quite often the
investigation of the environment starts at the moment an increased number of
patients is diagnosed with an invasive mould infection, while no adequate
background information exists about the level of environmental fungal contamination
before the outbreak. Air filtration methods like high efficiency particulate air (HEPA)
filtration and laminar airflow measurements are well established. The maintenance of
these systems should be done properly. Prospective particle counting should be
performed. Numerous outbreaks have been described due to insufficient functioning
of these ventilation systems. Investigation of the water and its tubing system should
be done properly and when the water is contaminated with moulds, preventive
measurements like point-of-use filtration or cleaning measurements should be
established. New, rapid quantitative PCR methods have been described which could
prompt the elimination of fungal pathogens from the water supply of
immunocompromised patients. During a period of construction work inside or around
the hospital, additional preventive measurements should be taken to deal with a
higher number of fungal spores in the environment. Quantitative PCR can be used to
monitor Aspergillus species in air during hospital construction. In case of an
outbreak, a thorough investigation of the environment is obligatory in order to
abandon the (potential) source of fungal contamination either be physically removing
the contaminated source or improving the filtration measurements. In the literature,
numerous sources have been detected, unexpectedly on forehand. From an
epidemiological point of view, molecular investigation of moulds either isolated from
patients or the environment will increase our understanding of the acquisition and
route of infection. Various molecular techniques are available to genotype moulds.
For Aspergillus fumigatus, the amplified fragment length polymorfism (AFLP) and the
short tandem repeat analysis seem to be the most discriminative typing methods.
Key references:
Warris A, Verweij P.E. Clinical implications of environmental sources for Aspergillus. Medical
Mycology 2005; 43(S): 59-65. Morrison J., Yang C, Lin K-T et al. Monitoring Aspergillus
species by quantitative PCR during construction of a multi-story hospital building. Journal of
Hospital Infection 2004; 57: 85-87. Nihtinen A, Antttila V-J, Richardson M et al. The utility of
intensified environmental surveillance for pathogenic moulds in a stem cell transplantation
ward during construction work to monitor the efficacy of HEPA filtration. Bone Marrow
Transplantation 2007; 40: 457-460.
Perdelli F, Cristina ML, Sartini M et al. Fungal contamination in hospital environments.
Infection Control and Hospital Epidemiology 2006; 27: 44-47. Vesper SJ, Rogers ME, Neely
AN et al. Opportunistic Aspergillus pathogens measured in home and hospital tap water by
quantitative PCR (QPCR). Journal of Water and Health 2007; 5: 427-431. Warris A, Klaassen
CHW, Meis JFGM, et al. Molecular epidemiology of Aspergillus fumigatus isolates recovered
from water, air and patients shows two clusters of genetically distinct strains. Journal Clinical
Microbiology 2003; 41: 4101-4106.
De Valk HA, Meis JF, de Pauw BE, et al. Comparison of two highly discriminatory molecular
fingerprinting assays for analysis of multiple Aspergillus fumigatus isolates from patients with
invasive aspergillosis. Journal Clinical Microbiology 2007; 45:1415-1419. |
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发表于 2007-11-2 21:15
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发表于 2007-11-2 23:34
