Neutropenia‐related aspergillosis in non‐transplant haematological patients hospitalised under ambient air versus purified air conditions
Open Access
- 23 February 2023
- Vol. 66 (6), 505-514
- https://doi.org/10.1111/myc.13576
Abstract
BackgroundTo reduce the risk of invasive aspergillosis (IA), air purification by high-efficiency particulate air filtration and laminar air flow (HEPA/LAF) is standard of care in allogeneic blood stem cell transplantation. Its use in non-transplant haematological patients is inconsistent. ObjectivesWe sought to assess the incidence and outcome of pulmonary IA in non-transplant patients with life-threatening neutropenia by comparing an ambient air hospitalisation period (2008-2011) with a subsequent HEPA/LAF hospitalisation period (2012-2014). Patients and MethodsWe compared 204 consecutive patients with acute myeloid leukaemia, acute lymphoblastic leukaemia or aplastic anaemia completing 534 neutropenia-related hospitalisations under ambient air conditions with 126 such patients completing 437 neutropenia-related hospitalisations under HEPA/LAF conditions. IA was defined using the 2008 EORTC/MSG criteria. ResultsWithin a 7-year study period, we observed one 'proven', three 'probable' and 73 'possible' IAs, most often during acute leukaemia remission induction. Their frequency rose with increasing duration of life-threatening neutropenia (1-10 days, 1.8%; >40 days, 35.2%) and concomitant severe anaemia (0 days, 3.2%; >20 days, 31.0%). Multiple logistic regression revealed a strong correlation between IA incidence and hospitalisation under HEPA/LAF conditions (odds ratio [OR], 0.368 [95% confidence interval, 0.207-0.654]; p < .001) and duration of neutropenia (OR, 1.043 [1.023-1.062] per day; p < .001) and anaemia (OR, 1.044 [1.008-1.081] per day; p = .016). IA-associated fatal outcomes were non-significantly reduced under HEPA/LAF (OR, 0.077 [0.005-1.151]; p = .063). The protective effect of HEPA/LAF was not seen under posaconazole prophylaxis (OR, 0.856 [0.376-1.950]; p = .711). ConclusionsImplementation of HEPA/LAF was associated with a significant reduction in neutropenia-related IA in non-transplant haematological patients.Keywords
This publication has 26 references indexed in Scilit:
- Guidelines on the management of anaemia and red cell transfusion in adult critically ill patientsBritish Journal of Haematology, 2012
- Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB*Annals of Internal Medicine, 2012
- Invasive aspergillosis in patients with acute myeloid leukemia: a SEIFEM-2008 registry studyHaematologica, 2009
- 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 GroupClinical Infectious Diseases, 2008
- Reduction of Invasive Aspergillosis Incidence among Immunocompromised Patients after Control of Environmental ExposureClinical Infectious Diseases, 2007
- Posaconazole vs. Fluconazole or Itraconazole Prophylaxis in Patients with NeutropeniaThe New England Journal of Medicine, 2007
- The Influence of High‐Efficiency Particulate Air Filtration on Mortality and Fungal Infection among Highly Immunosuppressed Patients: A Systematic ReviewThe Journal of Infectious Diseases, 2006
- Aspergillosis Case-Fatality Rate: Systematic Review of the LiteratureClinical Infectious Diseases, 2001
- Efficacy of Prevention by High-Efficiency Particulate Air Filtration or Laminar Airflow Against Aspergillus Airborne Contamination During Hospital RenovationInfection Control & Hospital Epidemiology, 1999
- Influence of protective isolation on outcome of allogeneic bone marrow transplantation for leukemiaBone Marrow Transplantation, 1998