Skip to main content

Advertisement

SpringerLink
Log in

Infection Control Measures to Prevent Invasive Mould Diseases in Hematopoietic Stem Cell Transplant Recipients

  • Published:
Mycopathologia Aims and scope Submit manuscript

Abstract

Invasive mould diseases, particularly aspergillosis, are important causes of morbidity and mortality in allogeneic stem cell transplant recipients. Mould spores are ubiquitous in the environment. Guidelines established by the Centers for Disease Control (CDC) and other authoritative organizations focus on approaches to reduce exposure to mould spores. These recommendations include avoidance of areas and activities expected to result in high levels of mould spores (e.g., construction, gardening) and use of specially designed units (protected environments) where additional standards (e.g., HEPA-filtered rooms) are in place to minimize mould exposure. These recommendations are based on consensus criteria and limited clinical data largely derived from single-center retrospective studies. In addition, highly immunocompromised stem cell transplant recipients are commonly managed as outpatients, where engineering standards of the inpatient protected environment are not feasible. In the absence of an outbreak with an identified environmental source (e.g., a contaminated air vent), it is not possible to reliably distinguish community-acquired from nosocomial aspergillosis. Adherence to infection control guidelines, acknowledging their limitations, combined with evidence-based targeted antifungal prophylaxis for the highest risk transplant recipients, is likely to be the most effective approach to prevent invasive mould diseases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Segal BH. Aspergillosis. N Engl J Med. 2009;360:1870–84.

    Article  CAS  PubMed  Google Scholar 

  2. van Burik JA, Carter SL, Freifeld AG, et al. Higher risk of cytomegalovirus and aspergillus infections in recipients of T cell-depleted unrelated bone marrow: analysis of infectious complications in patients treated with T cell depletion versus immunosuppressive therapy to prevent graft-versus-host disease. Biol Blood Marrow Transplant. 2007;13:1487–98.

    Article  PubMed  Google Scholar 

  3. Marr KA, Carter RA, Crippa F, Wald A, Corey L. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2002;34:909–17.

    Article  PubMed  Google Scholar 

  4. Jantunen E, Ruutu P, Niskanen L, et al. Incidence and risk factors for invasive fungal infections in allogeneic BMT recipients. Bone Marrow Transplant. 1997;19:801–8.

    Article  CAS  PubMed  Google Scholar 

  5. Morgan J, Wannemuehler KA, Marr KA, et al. Incidence of invasive aspergillosis following hematopoietic stem cell and solid organ transplantation: interim results of a prospective multicenter surveillance program. Med Mycol. 2005;43(Suppl 1):S49–58.

    Article  PubMed  Google Scholar 

  6. Boutati EI, Anaissie EJ. Fusarium, a significant emerging pathogen in patients with hematologic malignancy: ten years’ experience at a cancer center and implications for management. Blood. 1997;90:999–1008.

    CAS  PubMed  Google Scholar 

  7. Nucci M, Marr KA, Queiroz-Telles F, et al. Fusarium infection in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2004;38:1237–42. Epub 2004 Apr 15.

    Article  PubMed  Google Scholar 

  8. Halt M. Moulds and mycotoxins in herb tea and medicinal plants. Eur J Epidemiol. 1998;14:269–74.

    Article  CAS  PubMed  Google Scholar 

  9. Efuntoye MO. Fungi associated with herbal drug plants during storage. Mycopathologia. 1996;136:115–8.

    Article  PubMed  Google Scholar 

  10. Chang CC, Athan E, Morrissey CO, Slavin MA. Preventing invasive fungal infection during hospital building works. Intern Med J. 2008;38:538–41.

    Article  CAS  PubMed  Google Scholar 

  11. Weems JJ Jr, Davis BJ, Tablan OC, Kaufman L, Martone WJ. Construction activity: an independent risk factor for invasive aspergillosis and zygomycosis in patients with hematologic malignancy. Infect Control. 1987;8:71–5.

    PubMed  Google Scholar 

  12. Weber SF, Peacock JE Jr, Do KA, Cruz JM, Powell BL, Capizzi RL. Interaction of granulocytopenia and construction activity as risk factors for nosocomial invasive filamentous fungal disease in patients with hematologic disorders. Infect Control Hosp Epidemiol. 1990;11:235–42.

    Article  CAS  PubMed  Google Scholar 

  13. Thio CL, Smith D, Merz WG, et al. Refinements of environmental assessment during an outbreak investigation of invasive aspergillosis in a leukemia and bone marrow transplant unit. Infect Control Hosp Epidemiol. 2000;21:18–23.

    Article  CAS  PubMed  Google Scholar 

  14. Arnow PM, Sadigh M, Costas C, Weil D, Chudy R. Endemic and epidemic aspergillosis associated with in-hospital replication of Aspergillus organisms. J Infect Dis. 1991;164:998–1002.

    CAS  PubMed  Google Scholar 

  15. Manuel RJ, Kibbler CC. The epidemiology and prevention of invasive aspergillosis. J Hosp Infect. 1998;39:95–109.

    Article  CAS  PubMed  Google Scholar 

  16. Rhame FS. Prevention of nosocomial aspergillosis. J Hosp Infect. 1991;18(Suppl A):466–72.

    Article  PubMed  Google Scholar 

  17. Sarubbi FA Jr, Kopf HB, Wilson MB, McGinnis MR, Rutala WA. Increased recovery of Aspergillus flavus from respiratory specimens during hospital construction. Am Rev Respir Dis. 1982;125:33–8.

    PubMed  Google Scholar 

  18. Aisner J, Schimpff SC, Bennett JE, Young VM, Wiernik PH. Aspergillus infections in cancer patients. Association with fireproofing materials in a new hospital. JAMA. 1976;235:411–2.

    Article  CAS  PubMed  Google Scholar 

  19. Carter CD, Barr BA. Infection control issues in construction and renovation. Infect Control Hosp Epidemiol. 1997;18:587–96.

    Article  CAS  PubMed  Google Scholar 

  20. Munoz P, Burillo A, Bouza E. Environmental surveillance and other control measures in the prevention of nosocomial fungal infections. Clin Microbiol Infect. 2001;7(Suppl 2):38–45.

    Article  PubMed  Google Scholar 

  21. Dewhurst AG, Cooper MJ, Khan SM, Pallett AP, Dathan JR. Invasive aspergillosis in immunosuppressed patients: potential hazard of hospital building work. BMJ. 1990;301:802–4.

    Article  CAS  PubMed  Google Scholar 

  22. Leenders AC, van Belkum A, Behrendt M, Luijendijk A, Verbrugh HA. Density and molecular epidemiology of Aspergillus in air and relationship to outbreaks of Aspergillus infection. J Clin Microbiol. 1999;37:1752–7.

    CAS  PubMed  Google Scholar 

  23. Dykewicz CA. Hospital infection control in hematopoietic stem cell transplant recipients. Emerg Infect Dis. 2001;7:263–7.

    Article  CAS  PubMed  Google Scholar 

  24. Denning DW. Epidemiology and pathogenesis of systemic fungal infections in the immunocompromised host. J Antimicrob Chemother. 1991;28(Suppl B):1–16.

    PubMed  Google Scholar 

  25. Walsh TJ, Dixon DM. Nosocomial aspergillosis: environmental microbiology, hospital epidemiology, diagnosis and treatment. Eur J Epidemiol. 1989;5:131–42.

    Article  CAS  PubMed  Google Scholar 

  26. Sehulster L, Chinn RY. Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep. 2003;52:1–42.

    PubMed  Google Scholar 

  27. Rhame FS, Streifel AJ, Kersey JH Jr, McGlave PB. Extrinsic risk factors for pneumonia in the patient at high risk of infection. Am J Med. 1984;76:42–52.

    Article  CAS  PubMed  Google Scholar 

  28. Marks WH, Florence L, Lieberman J, et al. Successfully treated invasive pulmonary aspergillosis associated with smoking marijuana in a renal transplant recipient. Transplantation. 1996;61:1771–4.

    Article  CAS  PubMed  Google Scholar 

  29. Pitt JI, Hocking AD, Bhudhasamai K, Miscamble BF, Wheeler KA, Tanboon-Ek P. The normal mycoflora of commodities from Thailand. 1. Nuts and oilseeds. Int J Food Microbiol. 1993;20:211–26.

    Article  CAS  PubMed  Google Scholar 

  30. Studer-Rohr I, Dietrich DR, Schlatter J, Schlatter C. The occurrence of ochratoxin A in coffee. Food Chem Toxicol. 1995;33:341–55.

    Article  CAS  PubMed  Google Scholar 

  31. Bouakline A, Lacroix C, Roux N, Gangneux JP, Derouin F. Fungal contamination of food in hematology units. J Clin Microbiol. 2000;38:4272–3.

    CAS  PubMed  Google Scholar 

  32. De Bock R, Gyssens I, Peetermans M, Nolard N. Aspergillus in pepper. Lancet. 1989;2:331–2.

    Article  PubMed  Google Scholar 

  33. Oliver MR, Van Voorhis WC, Boeckh M, Mattson D, Bowden RA. Hepatic mucormycosis in a bone marrow transplant recipient who ingested naturopathic medicine. Clin Infect Dis. 1996;22:521–4.

    CAS  PubMed  Google Scholar 

  34. Kusne S, Krystofiak S. Infection control issues after bone marrow transplantation. Curr Opin Infect Dis. 2001;14:427–31.

    CAS  PubMed  Google Scholar 

  35. Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant. 2009;15:1143–238.

    Article  CAS  PubMed  Google Scholar 

  36. Kibbler CC. Epidemiology of fungal disease. In: Kibbler CC, Mackenzie DWR, Odds FC, editors. Principles and practice of clinical mycology. New York: John Wiley; 1996. p. 13–21.

    Google Scholar 

  37. Warris A, Gaustad P, Meis JF, Voss A, Verweij PE, Abrahamsen TG. Recovery of filamentous fungi from water in a paediatric bone marrow transplantation unit. J Hosp Infect. 2001;47:143–8.

    Article  CAS  PubMed  Google Scholar 

  38. Nucci M, Anaissie E. Fusarium infections in immunocompromised patients. Clin Microbiol Rev. 2007;20:695–704.

    Article  CAS  PubMed  Google Scholar 

  39. Anaissie EJ, Kuchar RT, Rex JH, et al. Fusariosis associated with pathogenic fusarium species colonization of a hospital water system: a new paradigm for the epidemiology of opportunistic mold infections. Clin Infect Dis. 2001;33:1871–8.

    Article  CAS  PubMed  Google Scholar 

  40. Raad I, Tarrand J, Hanna H, et al. Epidemiology, molecular mycology, and environmental sources of Fusarium infection in patients with cancer. Infect Control Hosp Epidemiol. 2002;23:532–7.

    Article  PubMed  Google Scholar 

  41. Mullins J, Hutcheson PS, Slavin RG. Aspergillus fumigatus spore concentration in outside air: Cardiff and St Louis compared. Clin Allergy. 1984;14:351–4.

    Article  CAS  PubMed  Google Scholar 

  42. Noble WC, Clayton YM. Fungi in the air of hospital wards. J Gen Microbiol. 1963;32:397–402.

    CAS  PubMed  Google Scholar 

  43. Loudon KW, Coke AP, Burnie JP, Shaw AJ, Oppenheim BA, Morris CQ. Kitchens as a source of Aspergillus niger infection. J Hosp Infect. 1996;32:191–8.

    Article  CAS  PubMed  Google Scholar 

  44. Saxen H, Virtanen M, Carlson P, et al. Neonatal Candida parapsilosis outbreak with a high case fatality rate. Pediatr Infect Dis J. 1995;14:776–81.

    Article  CAS  PubMed  Google Scholar 

  45. Sherertz RJ, Gledhill KS, Hampton KD, et al. Outbreak of Candida bloodstream infections associated with retrograde medication administration in a neonatal intensive care unit. J Pediatr. 1992;120:455–61.

    Article  CAS  PubMed  Google Scholar 

  46. Vazquez JA, Dembry LM, Sanchez V, et al. Nosocomial Candida glabrata colonization: an epidemiologic study. J Clin Microbiol. 1998;36:421–6.

    CAS  PubMed  Google Scholar 

  47. Sanchez V, Vazquez JA, Barth-Jones D, Dembry L, Sobel JD, Zervos MJ. Nosocomial acquisition of Candida parapsilosis: an epidemiologic study. Am J Med. 1993;94:577–82.

    Article  CAS  PubMed  Google Scholar 

  48. Hahn T, Cummings KM, Michalek AM, Lipman BJ, Segal BH, McCarthy PL Jr. Efficacy of high-efficiency particulate air filtration in preventing aspergillosis in immunocompromised patients with hematologic malignancies. Infect Control Hosp Epidemiol. 2002;23:525–31.

    Article  PubMed  Google Scholar 

  49. Anderson K, Morris G, Kennedy H, et al. Aspergillosis in immunocompromised paediatric patients: associations with building hygiene, design, and indoor air. Thorax. 1996;51:256–61.

    Article  CAS  PubMed  Google Scholar 

  50. Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control. 2007;35:S65–164.

    Article  PubMed  Google Scholar 

  51. Rice N, Streifel A, Vesley D. An evaluation of hospital special-ventilation-room pressures. Infect Control Hosp Epidemiol. 2001;22:19–23.

    Article  CAS  PubMed  Google Scholar 

  52. Hajjeh RA, Warnock DW. Counterpoint: invasive aspergillosis and the environment—rethinking our approach to prevention. Clin Infect Dis. 2001;33:1549–52.

    Article  CAS  PubMed  Google Scholar 

  53. Kusne S, Krystofiak S. Infection control issues after solid organ transplantation. In: Bowden RA, Ljungman P, Paya CV, editors. Transplant infections. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2003. p. 589–607.

    Google Scholar 

  54. Pizzo PA, Robichaud KJ, Gill FA, Witebsky FG. Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia. Am J Med. 1982;72:101–11.

    Article  CAS  PubMed  Google Scholar 

  55. Segal BH, Almyroudis NG, Battiwalla M, et al. Prevention and early treatment of invasive fungal infection in patients with cancer and neutropenia and in stem cell transplant recipients in the era of newer broad-spectrum antifungal agents and diagnostic adjuncts. Clin Infect Dis. 2007;44:402–9.

    Article  PubMed  Google Scholar 

  56. De Pauw B, Walsh TJ, Donnelly JP, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46:1813–21.

    Article  PubMed  Google Scholar 

  57. Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis. 2006;42:1417–727.

    Article  CAS  PubMed  Google Scholar 

  58. Segal BH, Freifeld AG, Baden LR, et al. Prevention and treatment of cancer-related infections. J Natl Compr Canc Netw. 2008;6:122–74.

    PubMed  Google Scholar 

  59. Einsele H, Loeffler J. Contribution of new diagnostic approaches to antifungal treatment plans in high-risk haematology patients. Clin Microbiol Infect. 2008;14(Suppl 4):37–45.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Infection Control, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA

    Kimberly Partridge-Hinckley, Gale M. Liddell, Nikolaos G. Almyroudis & Brahm H. Segal

  2. Department of Medicine, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA

    Nikolaos G. Almyroudis & Brahm H. Segal

  3. Department of Immunology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA

    Brahm H. Segal

Authors
  1. Kimberly Partridge-Hinckley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gale M. Liddell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nikolaos G. Almyroudis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brahm H. Segal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kimberly Partridge-Hinckley.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Partridge-Hinckley, K., Liddell, G.M., Almyroudis, N.G. et al. Infection Control Measures to Prevent Invasive Mould Diseases in Hematopoietic Stem Cell Transplant Recipients. Mycopathologia 168, 329–337 (2009). https://doi.org/10.1007/s11046-009-9247-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11046-009-9247-z

Keywords

Search

Navigation