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[血液科侵袭性曲霉病流行病学]

[Hematological unit invasive aspergillosis epidemiology].

作者信息

Maehara Yoriko, Nagasaki Yoji, Kadowaki Masako, Eriguchi Yoshihiro, Miyake Noriko, Uchida Yujiro, Nagafuji Koji, Shimono Nobuyuki

机构信息

Faculty of Medicine and Biosystemic Science, Graduate School of Medical Science, Kyushu University.

出版信息

Kansenshogaku Zasshi. 2010 Mar;84(2):176-81. doi: 10.11150/kansenshogakuzasshi.84.176.

Abstract

Invasive aspergillosis (IA) is a major cause of morbidity and mortality among the immunocompromised, especially those undergoing hematopoietic stem cell transplantation. With spore inhalation the usual infection route, such subjects must be protected from environmental spore contamination, necessitating measures such as high-efficiency particulate air (HEPA) filtration. In April 2006, we implemented a new transplantation unit with HEPA filtration. We retrospectively evaluated its efficacy for hospitalized transplantation unit subjects whose sera were tested for aspergillus galactomannan antigen between April 2004 and March 2007. Subjects numbered 265 (973 samples) categorized as definite, probable, or possible. The earliest IA onset date was when symptoms, positive radiological findings, or positive galactomannan antigen tests occurred, based on revised European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) definitions. We classified cases when IA occurred over 10 days after admission as hospital-acquired. No such cases were detected after November 2005 and IA incidence decreased significantly after the new unit began being used. Results suggest that the new unit and HEPA filtration helped eliminate nosocomial IA.

摘要

侵袭性曲霉病(IA)是免疫功能低下者发病和死亡的主要原因,尤其是接受造血干细胞移植的患者。由于通常通过吸入孢子感染,这类患者必须免受环境孢子污染,因此需要采取高效空气微粒过滤器(HEPA)过滤等措施。2006年4月,我们启用了配备HEPA过滤设备的新移植单元。我们对2004年4月至2007年3月期间在住院移植单元接受治疗且血清检测曲霉半乳甘露聚糖抗原的患者进行了回顾性评估。共有265名患者(973份样本),根据修订后的欧洲癌症研究与治疗组织/侵袭性真菌感染协作组及美国国立过敏与传染病研究所真菌病研究组(EORTC/MSG)的定义,分为确诊、疑似或可能病例。IA的最早发病日期依据症状、影像学检查结果阳性或半乳甘露聚糖抗原检测阳性确定。我们将入院10天后发生的IA病例归类为医院获得性感染。2005年11月后未检测到此类病例,新单元启用后IA发病率显著下降。结果表明,新单元和HEPA过滤有助于消除医院获得性IA。

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