Pittet D, Huguenin T, Dharan S, Sztajzel-Boissard J, Ducel G, Thorens J B, Auckenthaler R, Chevrolet J C
Infection Control Program, Division of Infectious Diseases, University Hospital of Geneva, Switzerland.
Am J Respir Crit Care Med. 1996 Aug;154(2 Pt 1):541-4. doi: 10.1164/ajrccm.154.2.8756836.
Two patients admitted to two different medical wards of our institution following respiratory decompensation of chronic obstructive pulmonary disease (COPD) were subsequently transferred to the same room of the medical intensive care unit (ICU) and intubated. Both patients developed invasive pulmonary aspergillosis and died soon after. Because COPD itself is rarely associated with lethal pulmonary aspergillosis, both cases were reviewed, and a retrospective investigation was conducted. Both patients had repeated sputum cultures while on the medical ward before their admission to the ICU; none of the sample grew Aspergillus spp. A. fumigatus was found in tracheal aspirates of both patients from the first day of their intubation while in the ICU. The pulmonary condition of both patients worsened, and invasive aspergillosis was diagnosed by bronchoalveolar lavage. Despite therapy with amphotericin B, the patients died 16 and 22 d after intubation, respectively. Both deaths were attributed to pulmonary aspergillosis; autopsy confirmed a massive pneumonia of the five lobes due to A. fumigatus in one patient. Investigation revealed that an air filter had been replaced 30 h before the first patient was admitted to the room. Experimental air filter replacement performed 12 d after the second patient died revealed the presence of A. fumigatus on the surface of the filters as well as a 10-fold increase in room air fungal counts during the procedure. This study shows that exposure to high concentrations of airborne Aspergillus spp. related to air filter change was associated with fatal invasive aspergillosis in two mechanically ventilated patients. Such infection can be prevented by the establishment and application of guidelines for air filter replacement.
两名因慢性阻塞性肺疾病（COPD）呼吸功能不全入住我院两个不同内科病房的患者，随后被转入内科重症监护病房（ICU）的同一房间并接受插管治疗。两名患者均发生侵袭性肺曲霉病，随后不久死亡。由于COPD本身很少与致命性肺曲霉病相关，因此对这两例病例进行了回顾，并开展了一项回顾性调查。两名患者在入住ICU之前在内科病房时均多次进行痰培养；所有样本均未培养出曲霉属真菌。在ICU期间，从两名患者插管第一天起，气管吸出物中均发现烟曲霉。两名患者的肺部状况均恶化，通过支气管肺泡灌洗诊断为侵袭性曲霉病。尽管使用两性霉素B进行治疗，但患者分别在插管后16天和22天死亡。两人均死于肺曲霉病；尸检证实其中一名患者因烟曲霉导致五个肺叶发生大面积肺炎。调查发现，在第一名患者入住该房间前30小时更换了空气过滤器。在第二名患者死亡12天后进行的空气过滤器更换实验显示，过滤器表面存在烟曲霉，并且在更换过程中室内空气真菌计数增加了10倍。本研究表明，与空气过滤器更换相关的高浓度空气传播曲霉属真菌暴露与两名机械通气患者的致命性侵袭性曲霉病有关。通过制定和应用空气过滤器更换指南可以预防此类感染。
