Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
BMC Infect Dis. 2019 Jan 9;19(1):38. doi: 10.1186/s12879-018-3665-9.
The preventive effect of laminar air flow (LAF) on aspergillosis has been observed in patients with hematological malignancies. However, the short follow-up period limits the interpretation of study results.
To assess the preventive effect of long-term LAF use on aspergillosis in its long-term use, we retrospectively analyzed 124 acute leukemia patients at our hospital between January 2005 and March 2016. We compared the incidence of aspergillosis before (May 2008) and during the construction of a new building (June 2008-January 2010) and in the early (February 2010-March 2014) and late (April 2014-March 2016) periods after moving to a new hematology ward with an LAF system. The 2008 European Organization for Research and Treatment of Cancer and Mycosis Study Group criteria were used for the diagnosis of aspergillosis.
Fourteen patients were diagnosed with possible, probable, or definite aspergillosis. Cumulative incidence rates of aspergillosis at day 180 were 12.4, 24.9, 9.3, and 25.1% before construction, during construction, in the early period after moving to a new ward, and in the late period after moving to a new ward, respectively (p = 0.106). Multivariate analysis showed that the LAF system tended to reduce the risk of aspergillosis in the early period (before construction vs. early period; hazards ratio (HR) = 1.97, p = 0.463 and during construction vs. early period;HR = 3.42, p = 0.184), but the risk increased in the late period (late vs. early period, HR = 5.65, p = 0.035).
Building construction might increase the risk of aspergillosis. Short-term LAF use might reduce aspergillosis risk, but its long-term use is inadequate, although we could not exclude the possibility of increased risks in the recent period due to continued improvements in the different areas of our hospital. Strict maintenance, more effective LAF system, and optimization of aspergillosis prophylaxis may be necessary.
层流空气（LAF）对血液病患者侵袭性曲霉病的预防作用已被观察到。然而，较短的随访时间限制了对研究结果的解释。
为了评估长期使用 LAF 对曲霉病的预防作用，我们回顾性分析了我院 2005 年 1 月至 2016 年 3 月间 124 例急性白血病患者。我们比较了在新建筑建设前（2008 年 5 月）、建设期间（2008 年 6 月至 2010 年 1 月）以及搬入新血液病病房后早期（2010 年 2 月至 2014 年 3 月）和晚期（2014 年 4 月至 2016 年 3 月）使用 LAF 系统时的曲霉病发生率。采用 2008 年欧洲癌症研究与治疗组织和真菌病研究组标准诊断曲霉病。
14 例患者被诊断为疑似、可能或确诊的侵袭性曲霉病。第 180 天的累积曲霉病发生率分别为 12.4%、24.9%、9.3%和 25.1%，分别为建设前、建设期间、搬入新病房早期和搬入新病房晚期（p=0.106）。多变量分析显示，LAF 系统在早期（建设前 vs. 早期；风险比（HR）=1.97，p=0.463 和建设期间 vs. 早期；HR=3.42，p=0.184）时倾向于降低曲霉病的风险，但在晚期（晚期 vs. 早期，HR=5.65，p=0.035）时风险增加。
建筑施工可能会增加曲霉病的风险。短期使用 LAF 可能会降低曲霉病的风险，但长期使用效果不佳，尽管我们不能排除由于医院不同领域的持续改进而导致近期风险增加的可能性。严格的维护、更有效的 LAF 系统以及优化曲霉病预防措施可能是必要的。
