Aspergillus spp and other opportunistic fungi in the hospital water systems in two cities: epidemiologic studies and implications for patient care.

EJ Anaissie, R Kuchar, TP Monson, SL Stratton


Background: Aspergillus spp., Fusarium spp., Paecilomyces lilacinus, and the demateacious fungi have been reported as significant causes of morbidity and mortality in patients with hematological cancer, and their incidence continues to increase despite the use of HEPA filters. These fungi have been previously reported from municipal water systems nationwide.Purpose: To determine whether the water delivered to city municipalities to hospitals is a source for opportunistic fungi in hospital settings including in HEPA-filtered areas.Setting: Three hospitals: one in Houston and two in Little Rock.Methods: We collected swab and water samples from hospital water tanks, sinks, showers, and related surfaces in various pt care areas including those equipped with HEPA filters. We also evaluated aerobiologic sampling in pt rooms, bathrooms, showers, and hallways. Swab samples were obtained using the BBL Culturette system. Water samples were collected in sterile bottles and filtered through 0.45 µ. filters. Swabs or filters were aseptically placed on Sab Dex Agar and/or Malt Extract Agar and incubated at 37C for ³ 48 hours. Air samples were acquired using an Andersen sampler and examined as above.Results: Fungi were recovered from 36% of water samples, 39% of water-related surfaces, and 34% of air samples. Water yielded Aspergillus spp, Fusarium spp, P. lilacinus, Alternaria spp., Bipolaris spp Phialophora spp and Zygomycetes. Surfaces that yielded fungi included sink drains, shower surfaces, and water fountain filter surfaces, and the hospital water tank in the Houston hospital. Cultures from pt showers yielded Aspergillus, Fusarium spp and P. lilacinus.Conclusion: Municipality water delivered to hospitals is a source of and a reservoir for opportunistic fungi. Measures aimed at preventing the exposure of high-risk patients with hematological cancers to water and water-related structures should be implemented at institutions caring for such patients.

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39th meeting of the American Society for Haemotology
    • ASH 39th (1998)