ASPERGILLOSIS IN A TRANSPLANT ICU: POSSIBLE PERSON-TO-PERSON AIRBORNE TRANSMISSION

David A Pegues, Michael M McNeil, Brent A Lasker, Judith I Lundal, Bernard M Kubak, Patricia M Hamm, Lee Ann Cook, Maureen E Keckeisen, Ronald W Busuttil

Abstract: 

Background: Aspergillus wound infection is a serious complication of liver transplantation. In Sept. 1998, a patient developed deep surgical site and organ space infection with Aspergillus fumigatus 8 days after a second liver transplant. The patient was transferred to an open cubicle in the 11-bed Transplant ICU, where the abdominal wound was debrided and wet-to-dry dressing changes were performed. In Oct. 1998, two patients in this ICU were diagnosed with invasive pulmonary A. fumigatus infection. Methods: To determine sources of A. fumigatus, we placed settle plates in the Transplant ICU and performed air sampling for 30 minutes before and after changing the index patient s wound dressings. A. fumigatus isolates were subtyped by RFLP analysis of EcoRI genomic blots hybridized with the species-specific DNA probe, lambda 3.9. Results: From Sept. to Oct. 1998, the rate of nosocomial aspergillosis on the liver service was 10-fold higher compared with Jan. 1997-Aug. 1998 (2.4 vs. 0.25 per 1000 patients; P=0.007). After settle plates placed next to the index patient grew 4 and 15 colonies of A. fumigatus compared with 0-4 colonies per plate (median, 0) elsewhere in the ICU, the index patient was moved to a private room and portable HEPA-filtration units were placed inside and outside the room. Settle plates placed inside the room grew no colonies of A. fumigatus before, and 19 and 34 colonies after a dressing change. Similarly, air samples outside the room grew 0 and 1 colony of A. fumigatus before, and 3 and 87 colonies after a dressing change. The index patient was transferred from the ICU to a negative-pressure isolation room, where he died. A. fumigatus tissue isolates from this patient and a sputum isolate of one of the two other patients had an identical subtype (strain 1). A sputum isolate from the third patient had a unique subtype. Strain 1 also was identified in a preliminary analysis of the environmental A. fumigatus isolates obtained following dressing changes. Conclusion: This is the first report of probable person-to-person transmission of Aspergillus. Debriding and dressing wounds infected with Aspergillus may result in aerosolization of spores and airborne transmission.
1999

abstract No: 

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Full conference title: 

37th Annual Meeting of the Infectious Diseases Society of America (IDSA), November 18-21.
    • IDSA 37th