Prevention, control and management of inavsive aspergillosis at Edouard Herriot hospital : contribution of enviropnmental-clinical surveys and alert systems

Lors de travaux, la mise en suspension des spores d’Aspergillus constitue un facteur de risque reconnu dans le développement d’une aspergillose invasive. Durant l’année 2015, un pavillon de 6000 m2 (60 lits) de notre établissement a été entièrement déconstruit. L’objectif principal de cette étude a été d’évaluer l’association entre la concentration des spores d’Aspergillus fumigatus (AF) dans l’environnement extérieur et intérieur des pavillons, mais également avec la coexistence de cas cliniques, afin de proposer des recommandations d’amélioration (pratiques & techniques). Pour cela, durant 11 mois, une surveillance prospective de la contamination à Aspergillus fumigatus (AF) de l’air extérieur et intérieur par impaction sur gélose, mais aussi une investigation épidémiologique des patients à risque ont été mis en place. Au total, 3885 prélèvements d’air ont été réalisés (1744 extérieurs et 2141 intérieurs) permettant, par calcul des ratios de contamination (extérieurs vs intérieurs), de confirmer une efficacité des mesures de précautions pour réduire l’aérocontamination. Des prélèvements extérieurs continus des spores d’Aspergillacées (spore/m3/jour) ont également été réalisés par un capteur Hirst. Ce capteur, mais aussi le suivi des conditions météorologiques se sont révélés être des systèmes d’alerte utiles pour prévenir les pics de contamination. Enfin, 394 (383 environnementaux, 11 cliniques) isolats d’AF sensibles aux antifongiques ont été génotypés (MLVA). L’analyse des génotypes a montré 7 génotypes similaires entre des isolats d’AF cliniques et environnementaux confirmant un rôle de l’environnement hospitalier dans l’infection ou la colonisation des patientsInvasive aspergillosis (IA) due to Aspergillus has been associated with building construction, which may increase spores emission nearby immunocompromised patients. In 2015, one blocks of 6,000 m2 (60 beds) form our hospital has been entirely demolished. The aim of this study was to evaluate possible association between concentration of A. fumigatus (AF) spores in the outdoor and indoor environment and also with the clinical cases in order to propose some improvements in actuals methods and practices. A daily surveillance of fungal contamination was implemented during 11-months. Environmental survey was realized by air samplings, outdoor and indoor, with an automatic agar sampler. In parallel, surveillance of IA infection cases was conducted by epidemiological investigation. A total of 3885 air samples (1744 outdoor samples and 2141 indoor samples) were collected, allowing calculation of ratios (outdoor vs indoor) to confirm efficacy of preventives measures applied to reduce indoor aerocontamination. Outdoor continuous sampling of Aspergillaceae spores (spore/m3/day) was also realized by a Hirst collector. This collector was useful as alarm system to detect contamination peaks. Similarly, monitoring of meteorological parameters seems to be an interesting tool, to prevent Aspergillus peaks. Finally, 394 isolates of AF, susceptible to antifungals (383 environmental and 11 clinical isolates) were genotyped using MLVA. Analysis of genotypes showed 7 similar genotypes shared by environmental and clinical isolates, suggesting that clinical colonization and/or infection may originate from the hospital environmen

Prévention, contrôle et maîtrise du risque d’aspergillose invasive au Groupement Hospitalier Edouard Herriot lors de travaux : apport de la surveillance et de l’alerte environnementale et épidémiologique

Invasive aspergillosis (IA) due to Aspergillus has been associated with building construction, which may increase spores emission nearby immunocompromised patients. In 2015, one blocks of 6,000 m2 (60 beds) form our hospital has been entirely demolished. The aim of this study was to evaluate possible association between concentration of A. fumigatus (AF) spores in the outdoor and indoor environment and also with the clinical cases in order to propose some improvements in actuals methods and practices. A daily surveillance of fungal contamination was implemented during 11-months. Environmental survey was realized by air samplings, outdoor and indoor, with an automatic agar sampler. In parallel, surveillance of IA infection cases was conducted by epidemiological investigation. A total of 3885 air samples (1744 outdoor samples and 2141 indoor samples) were collected, allowing calculation of ratios (outdoor vs indoor) to confirm efficacy of preventives measures applied to reduce indoor aerocontamination. Outdoor continuous sampling of Aspergillaceae spores (spore/m3/day) was also realized by a Hirst collector. This collector was useful as alarm system to detect contamination peaks. Similarly, monitoring of meteorological parameters seems to be an interesting tool, to prevent Aspergillus peaks. Finally, 394 isolates of AF, susceptible to antifungals (383 environmental and 11 clinical isolates) were genotyped using MLVA. Analysis of genotypes showed 7 similar genotypes shared by environmental and clinical isolates, suggesting that clinical colonization and/or infection may originate from the hospital environmentLors de travaux, la mise en suspension des spores d’Aspergillus constitue un facteur de risque reconnu dans le développement d’une aspergillose invasive. Durant l’année 2015, un pavillon de 6000 m2 (60 lits) de notre établissement a été entièrement déconstruit. L’objectif principal de cette étude a été d’évaluer l’association entre la concentration des spores d’Aspergillus fumigatus (AF) dans l’environnement extérieur et intérieur des pavillons, mais également avec la coexistence de cas cliniques, afin de proposer des recommandations d’amélioration (pratiques & techniques). Pour cela, durant 11 mois, une surveillance prospective de la contamination à Aspergillus fumigatus (AF) de l’air extérieur et intérieur par impaction sur gélose, mais aussi une investigation épidémiologique des patients à risque ont été mis en place. Au total, 3885 prélèvements d’air ont été réalisés (1744 extérieurs et 2141 intérieurs) permettant, par calcul des ratios de contamination (extérieurs vs intérieurs), de confirmer une efficacité des mesures de précautions pour réduire l’aérocontamination. Des prélèvements extérieurs continus des spores d’Aspergillacées (spore/m3/jour) ont également été réalisés par un capteur Hirst. Ce capteur, mais aussi le suivi des conditions météorologiques se sont révélés être des systèmes d’alerte utiles pour prévenir les pics de contamination. Enfin, 394 (383 environnementaux, 11 cliniques) isolats d’AF sensibles aux antifongiques ont été génotypés (MLVA). L’analyse des génotypes a montré 7 génotypes similaires entre des isolats d’AF cliniques et environnementaux confirmant un rôle de l’environnement hospitalier dans l’infection ou la colonisation des patient

Interaction between human dendritic cells and micro-organisms involved in hypersensitivity pneumonitis

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Evaluation of hirst-type spore trap to monitor environmental fungal load in hospital.

The main purpose was to validate the use of outdoor-indoor volumetric impaction sampler with Hirst-type spore traps (HTSTs) to continuously monitor fungal load in order to prevent invasive fungal infections during major structural work in hospital settings. For 4 weeks, outdoor fungal loads were quantified continuously by 3 HTSTs. Indoor air was sampled by both HTST and viable impaction sampler. Results were expressed as particles/m3 (HTST) or colony-forming units (CFU)/m3 (biocollector). Paired comparisons by day were made with Wilcoxon's paired signed-rank test or paired Student's t-test as appropriate. Paired airborne spore levels were correlated 2 by 2, after log-transformation with Pearson's cross-correlation. Concordance was calculated with kappa coefficient (κ). Median total fungal loads (TFLs) sampled by the 3 outdoor HTSTs were 3,025.0, 3,287.5 and 3,625.0 particles/m3 (P = 0.6, 0.6 and 0.3).-Concordance between Aspergillaceae fungal loads (AFLs, including Aspergillus spp. + Penicillium spp.) was low (κ = 0.2). A low positive correlation was found between TFLs sampled with outdoor HTST and indoor HTST with applying a 4-hour time lag, r = 0.30, 95% CI (0.23-0.43), P<0.001. In indoor air, Aspergillus spp. were detected by the viable impaction sampler on 63.1% of the samples, whereas AFLs were found by HTST-I on only 3.6% of the samples. Concordance between Aspergillus spp. loads and AFLs sampled with the 2 methods was very low (κ = 0.1). This study showed a 4-hour time lag between increase of outdoor and indoor TFLs, possibly due to insulation and aeraulic flow of the building. Outdoor HTSTs may permit to quickly identify (after 48 hours) time periods with high outdoor fungal loads. An identified drawback is that a too low sample area read did not seem to enable detection of Aspergillaceae spores efficiently. Indoor HTSTs may not be recommended at this time, and outdoor HTSTs need further study. Air sampling by viable impaction sampler remains the reference tool for quantifying fungal contamination of indoor air in hospitals

Prospective survey of azole drug resistance among environmental and clinical isolates of Aspergillus fumigatus in a French University hospital during major demolition works

International audienceOBJECTIVES: Recent studies have reported the emerging worldwide problem of azole drug resistance of A.~fumigatus isolates. The aim of this study was to evaluate the antifungal susceptibilities of A.~fumigatus isolates recovered from air and clinical samples collected in a French University hospital (Lyon), which underwent major deconstruction works over a one year-period. METHODS: A daily surveillance of fungal contamination was implemented during 11-months. Environmental survey was realized by air samplings, outdoor and indoor, with an automatic agar sampler. In parallel, surveillance of IA infection cases was conducted by epidemiological investigation. Environmental and clinical isolates of A.~fumigatus were identified by conventional methods and β-tubulin sequencing. Susceptibility testing of A.~fumigatus isolates against Itraconazole (ITZ), Voriconazole (VCZ) was performed using Etest method. RESULTS: A total of 3885 air samples (1744 outdoor samples and 2141 indoor samples) were collected. From the 3073 identified colonies of A.~fumigatus, 400 A.~fumigatus isolates were tested for their susceptibility to ITZ and VCZ, including 388 isolates coming from the environment (indoor n:157, outdoor n:231) and 12 isolates coming from clinical samples. All the 400 isolates were susceptible to azoles (<=1μg/mL). CONCLUSIONS: No environmental reservoir of A.~fumigatus azole resistant strains was found in our hospital which was undergoing major demolition works. Further studies with larger number of A.~fumigatus clinical isolates and environmental isolates from agricultural areas and healthcare establishments are needed to better appreciate the occurrence and prevalence of azole resistance

Evaluation of Hirst-type spore traps in outdoor Aspergillaceae monitoring during large demolition work in hospital

International audienceDemolition can generate fungal spore suspensions in association with various adverse health effects, such as high risk of invasive aspergillosis in immunocompromised patients. One block of Edouard Herriot Hospital was entirely demolished. The aim of the present study was to evaluate Hirst-type spore traps utility in monitoring outdoor Aspergillaceae (Aspergillus spp. + Penicillium spp.) spores in part of Edouard Herriot Hospital (Lyon, France) undergoing major demolition. Three periods were scheduled in 2015: (A) Gutting of building and asbestos removal, (B) Demolition of floors, (C) Excavation and earthwork. Outdoor Aspergillaceae fungal load was monitored by cultivable (Air Ideal\textregistered, bioMérieux) and non-cultivable methods (Lanzoni VPPS-2000, Analyzair\textregistered, Bologna, Italy). Differences of Aspergillaceae recorded with Hirst-type spore traps were observed between Gerland and Edouard Herriot Hospital. Differences between Aspergillaceae were recorded between day time and night time at Gerland and Edouard Herriot Hospital. Daily paired differences between Aspergillaceae recorded with non-cultivable methodology at Edouard Herriot Hospital and in an area without demolition work were significant in Period A vs Period B (p = 10-4) and Period A vs Period C (p = 10-4). Weak correlation of daily Aspergillaceae recorded by both methods at Edouard Herriot Hospital was significant only for Period C (r = 0.26, p = 0.048, n = 58). Meteorological parameters and type of demolition works were found to heavily influenced Aspergillaceae dispersion. Non-cultivable methodology is a promising tool for outdoor Aspergillaceae scrutiny during major demolition work in hospital, helping infection control staff to rapidly implement control measures

Description of outdoor total fungal loads loads sampled by HTST-O1, -O2 and–C.

<p>NOTE: HTST: Hirst-type spore trap. O1 and O2: placed outdoor, above the entrance porch of the transplant unit building (HTST-O1) and on the roof of the infection control building (HTST-O2). C: control, placed outdoor, outside the hospital, 5 km away, in a residential area. The differences between the median total fungal load between HTST-O1, -O2 and -C were not statistically significant (HTST-O1 <i>vs</i>. O2: <i>P</i> = 0.6, O2 <i>vs</i>. C: <i>P</i> = 0.6, O1 <i>vs</i>. C: <i>P</i> = 0.3, with Wilcoxon’s paired signed-rank test using Hochberg’s procedure).</p

Bacterial Cross-Transmission between Inanimate Surfaces and Patients in Intensive Care Units under Real-World Conditions: A Repeated Cross-Sectional Study

Background/Objectives: Contaminated surfaces play an important role in the nosocomial infection of patients in intensive care units (ICUs). This study, conducted in two ICUs at Edouard Herriot Hospital (Lyon, France), aimed to describe rooms&rsquo; microbial ecology and explore the potential link between environmental contamination and patients&rsquo; colonization and/or infection. Methods: Environmental samples were realized once monthly from January 2020 to December 2021 on surfaces close to the patient (bedrails, bedside table, and dedicated stethoscope) and healthcare workers&rsquo; high-touch surfaces, which were distant from the patient (computer, worktop/nurse cart, washbasin, and hydro-alcoholic solution/soap dispenser). Environmental bacteria were compared to the cultures of the patients hospitalized in the sampled room over a period of &plusmn; 10 days from the environmental sampling. Results: Overall, 137 samples were collected: 90.7% of the samples close to patients, and 87.9% of the distant ones were positives. Overall, 223 bacteria were isolated, mainly: Enterococcus faecalis (15.7%), Pantoea agglomerans (8.1%), Enterobacter cloacae/asburiae (6.3%), Bacillus cereus and other Bacillus spp (6.3%), Enterococcusfaecium (5.8%), Stenotrophomonas maltophilia (5.4%), and Acinetobacter baumannii (4.9%). Throughout the study, 142 patients were included, of which, n = 67 (47.2%) were infected or colonized by at least one bacterium. In fourteen cases, the same bacterial species were found both in environment and patient samples, with the suspicion of a cross-contamination between the patient&ndash;environment (n = 10) and environment&ndash;patient (n = 4). Conclusions: In this work, we found a high level of bacterial contamination on ICU rooms&rsquo; surfaces and described several cases of potential cross-contamination between environment and patients in real-world conditions

Description of environmental fungal loads collected by HTSTs and viable impaction sampler.

<p>Description of environmental fungal loads collected by HTSTs and viable impaction sampler.</p