Dananché Cédric, Gustin Marie-Paule, Cassier Pierre, Loeffert Sophie Tiphaine, Thibaudon Michel, Bénet Thomas, Vanhems Philippe
Unité d'hygiène, épidémiologie et prévention, Groupement Hospitalier Centre, Hospices Civils de Lyon, France.
Laboratoire des Pathogènes Emergents-Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, France.
PLoS One. 2017 May 9;12(5):e0177263. doi: 10.1371/journal.pone.0177263. eCollection 2017.
The main purpose was to validate the use of outdoor-indoor volumetric impaction sampler with Hirst-type spore traps (HTSTs) to continuously monitor fungal load in order to prevent invasive fungal infections during major structural work in hospital settings. For 4 weeks, outdoor fungal loads were quantified continuously by 3 HTSTs. Indoor air was sampled by both HTST and viable impaction sampler. Results were expressed as particles/m3 (HTST) or colony-forming units (CFU)/m3 (biocollector). Paired comparisons by day were made with Wilcoxon's paired signed-rank test or paired Student's t-test as appropriate. Paired airborne spore levels were correlated 2 by 2, after log-transformation with Pearson's cross-correlation. Concordance was calculated with kappa coefficient (κ). Median total fungal loads (TFLs) sampled by the 3 outdoor HTSTs were 3,025.0, 3,287.5 and 3,625.0 particles/m3 (P = 0.6, 0.6 and 0.3).-Concordance between Aspergillaceae fungal loads (AFLs, including Aspergillus spp. + Penicillium spp.) was low (κ = 0.2). A low positive correlation was found between TFLs sampled with outdoor HTST and indoor HTST with applying a 4-hour time lag, r = 0.30, 95% CI (0.23-0.43), P<0.001. In indoor air, Aspergillus spp. were detected by the viable impaction sampler on 63.1% of the samples, whereas AFLs were found by HTST-I on only 3.6% of the samples. Concordance between Aspergillus spp. loads and AFLs sampled with the 2 methods was very low (κ = 0.1). This study showed a 4-hour time lag between increase of outdoor and indoor TFLs, possibly due to insulation and aeraulic flow of the building. Outdoor HTSTs may permit to quickly identify (after 48 hours) time periods with high outdoor fungal loads. An identified drawback is that a too low sample area read did not seem to enable detection of Aspergillaceae spores efficiently. Indoor HTSTs may not be recommended at this time, and outdoor HTSTs need further study. Air sampling by viable impaction sampler remains the reference tool for quantifying fungal contamination of indoor air in hospitals.
主要目的是验证使用带有赫斯特型孢子捕捉器（HTSTs）的室外-室内容积撞击采样器来持续监测真菌负荷，以便在医院环境中的大型结构工程期间预防侵袭性真菌感染。连续4周，通过3个HTSTs对室外真菌负荷进行连续定量。室内空气通过HTST和活菌撞击采样器进行采样。结果以颗粒数/立方米（HTST）或菌落形成单位（CFU）/立方米（生物采样器）表示。根据情况使用威尔科克森配对符号秩检验或配对学生t检验进行每日配对比较。经对数转换后，使用皮尔逊交叉相关性对配对的空气传播孢子水平进行两两相关性分析。使用kappa系数（κ）计算一致性。3个室外HTSTs采样的真菌总负荷（TFLs）中位数分别为3025.0、3287.5和3625.0颗粒/立方米（P = 0.6、0.6和0.3）。曲霉科真菌负荷（AFLs，包括曲霉属+青霉属）之间的一致性较低（κ = 0.2）。在应用4小时时间滞后的情况下，室外HTST采样的TFLs与室内HTST采样的TFLs之间存在低正相关，r = 0.30，95%置信区间（0.23 - 0.43），P<0.001。在室内空气中，活菌撞击采样器在63.1%的样本中检测到曲霉属，而HTST - I仅在3.6%的样本中检测到AFLs。两种方法采样的曲霉属负荷与AFLs之间的一致性非常低（κ = 0.1）。本研究表明，室外和室内TFLs增加之间存在4小时的时间滞后，这可能是由于建筑物的隔热和气流所致。室外HTSTs可能有助于快速识别（48小时后）室外真菌负荷较高的时间段。一个已确定的缺点是，过低的样本面积读数似乎无法有效地检测到曲霉科孢子。目前可能不推荐使用室内HTSTs，室外HTSTs需要进一步研究。活菌撞击采样器进行空气采样仍然是量化医院室内空气真菌污染的参考工具。
