Oren I, Haddad N, Finkelstein R, Rowe J M
Infectious Diseases Unit, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Am J Hematol. 2001 Apr;66(4):257-62. doi: 10.1002/ajh.1054.
Between September 1993 and December 1993, during extensive hospital construction and indoor renovation, a nosocomial outbreak of invasive pulmonary aspergillosis occurred in acute leukemia patients treated in a regular ward that has only natural ventilation. The observed infection rate was 50%. Chemoprophylaxis with intravenous continuous low-dose amphotericin B was then instituted as a preventive measure. During the next 18 months invasive pulmonary aspergillosis developed in 43% of acute leukemia patients. After that period a new hematology ward was opened with an air filtration system through high-efficiency particulate air filtration (HEPA) filters, and a bone marrow transplantation program was started on the hematology service. During the following three years, none of the acute leukemia or bone marrow transplantation patients who were hospitalized exclusively in the hematology ward developed invasive pulmonary aspergillosis, although 29% of acute leukemia patients who were housed in a regular ward, because of shortage of space in the new facility, still contracted invasive pulmonary aspergillosis. Overall, 31 patients were diagnosed with invasive pulmonary aspergillosis during almost five years: 74% of patients recovered from invasive pulmonary aspergillosis, and 42% are long-term survivors; 26% of patients died of resistant leukemia with aspergillosis, but no one died of invasive pulmonary aspergillosis alone. In conclusion, during an on-going construction period, an extremely high incidence rate of invasive pulmonary aspergillosis in acute leukemia patients undergoing intensive chemotherapy was observed. Institution of low-dose intravenous amphotericin B prophylaxis marginally reduced the incidence rate of invasive pulmonary aspergillosis. Keeping patients in a special ward with air filtration through a HEPA system eliminated invasive pulmonary aspergillosis completely. Among patients who developed invasive pulmonary aspergillosis, early diagnosis and treatment are probably the explanation for the favorable outcome.
1993年9月至1993年12月期间，在大规模医院建设和室内装修过程中，一所仅采用自然通风的普通病房中，接受治疗的急性白血病患者发生了医院内侵袭性肺曲霉病暴发。观察到的感染率为50%。随后采取静脉持续低剂量两性霉素B进行化学预防作为预防措施。在接下来的18个月里，43%的急性白血病患者发生了侵袭性肺曲霉病。在此之后，一个配备高效空气过滤器（HEPA）空气过滤系统的新血液科病房启用，血液科开始了骨髓移植项目。在随后的三年里，仅在血液科病房住院的急性白血病或骨髓移植患者中，没有一人发生侵袭性肺曲霉病，尽管由于新设施空间不足，仍有29%在普通病房住院的急性白血病患者感染了侵袭性肺曲霉病。总体而言，在近五年中有31例患者被诊断为侵袭性肺曲霉病：74%的患者从侵袭性肺曲霉病中康复，42%为长期存活者；26%的患者死于耐药性白血病合并曲霉病，但没有一人仅死于侵袭性肺曲霉病。总之，在持续施工期间，观察到接受强化化疗的急性白血病患者侵袭性肺曲霉病发病率极高。采用低剂量静脉注射两性霉素B预防措施可略微降低降低侵袭性肺曲霉病发病率。将患者安置在配备HEPA系统空气过滤的特殊病房可完全消除侵袭性肺曲霉病。在发生侵袭性肺曲霉病的患者中，早期诊断和治疗可能是取得良好预后的原因。
