Fernandez-Gerlinger Marie-Paule, Jannot Anne-Sophie, Rigaudeau Sophie, Lambert Juliette, Eloy Odile, Mignon François, Farhat Hassan, Castaigne Sylvie, Merrer Jacques, Rousselot Philippe
1Service de Biologie Médicale,Centre Hospitalier de Versailles,Le Chesnay,France.
2Service d'informatique médicale,de biostatistique et de Santé Publique,Hôpital européen Georges Pompidou,AP-HP,Paris,France.
Infect Control Hosp Epidemiol. 2016 Jul;37(7):845-51. doi: 10.1017/ice.2016.81.
OBJECTIVE Invasive aspergillosis (IA) is a rare but severe infection caused by Aspergillus spp. that often develops in immunocompromised patients. Lethality remains high in this population. Therefore, preventive strategies are of key importance. The impact of a mobile air decontamination system (Plasmair, AirInSpace, Montigny-le-Bretonneux, France) on the incidence of IA in neutropenic patients was evaluated in this study. DESIGN Retrospective cohort study METHODS Patients with chemotherapy-induced neutropenia lasting 7 days or more were included over a 2-year period. Cases of IA were confirmed using the revised European Organization for Research and Treatment of Cancer (EORTC) criteria. We took advantage of a partial installation of Plasmair systems in the hematology intensive care unit during this period to compare patients treated in Plasmair-equipped versus non-equipped rooms. Patients were assigned to Plasmair-equipped or non-equipped rooms depending only on bed availability. Differences in IA incidence in both groups were compared using Fisher's exact test, and a multivariate analysis was performed to take into account potential confounding factors. RESULTS Data from 156 evaluable patients were available. Both groups were homogenous in terms of age, gender, hematological diagnosis, duration of neutropenia, and prophylaxis. A total of 11 cases of probable IA were diagnosed: 10 in patients in non-equipped rooms and only 1 patient in a Plasmair-equipped room. The odds of developing IA were much lower for patients hospitalized in Plasmair-equipped rooms than for patients in non-equipped rooms (P=.02; odds ratio [OR] =0.11; 95% confidence interval [CI], 0.00-0.84). CONCLUSION In this study, Plasmair demonstrated a major impact in reducing the incidence of IA in neutropenic patients with hematologic malignancies. Infect Control Hosp Epidemiol 2016;37:845-851.
目的 侵袭性曲霉病(IA)是一种由曲霉属真菌引起的罕见但严重的感染,常发生于免疫功能低下的患者。该人群的致死率仍然很高。因此,预防策略至关重要。本研究评估了一种移动空气净化系统(Plasmair,AirInSpace,法国蒙蒂尼勒布雷托讷)对中性粒细胞减少患者IA发病率的影响。
设计 回顾性队列研究
方法 在两年期间纳入化疗引起的中性粒细胞减少持续7天或更长时间的患者。IA病例根据修订后的欧洲癌症研究与治疗组织(EORTC)标准确诊。在此期间,我们利用血液科重症监护病房部分安装了Plasmair系统的情况,比较在配备Plasmair系统的房间和未配备该系统的房间接受治疗的患者。患者仅根据床位可用性被分配到配备Plasmair系统或未配备该系统的房间。使用Fisher精确检验比较两组IA发病率的差异,并进行多变量分析以考虑潜在的混杂因素。
结果 有156例可评估患者的数据。两组在年龄、性别、血液学诊断、中性粒细胞减少持续时间和预防措施方面均具有同质性。共诊断出11例可能的IA:10例在未配备系统的房间的患者中,仅1例在配备Plasmair系统的房间的患者中。在配备Plasmair系统的房间住院的患者发生IA的几率比在未配备系统的房间的患者低得多(P = 0.02;优势比[OR]=0.11;95%置信区间[CI],0.00 - 0.84)。
结论 在本研究中,Plasmair在降低血液系统恶性肿瘤中性粒细胞减少患者的IA发病率方面显示出重大影响。《感染控制与医院流行病学》2016年;37:845 - 851。