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Bonnal C, Leleu C, Brugière O, Chochillon C, Porcher R, Boelle PY, Menotti J, Houze S, Lucet JC, Derouin F. Relationship between Fungal Colonisation of the Respiratory Tract in Lung Transplant Recipients and Fungal Contamination of the Hospital Environment. PLoS One 2015; 10:e0144044. [PMID: 26629994 PMCID: PMC4667873 DOI: 10.1371/journal.pone.0144044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 11/12/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Aspergillus colonisation is frequently reported after lung transplantation. The question of whether aspergillus colonisation is related to the hospital environment is crucial to prevention. METHOD To elucidate this question, a prospective study of aspergillus colonisation after lung transplantation, along with a mycological survey of the patient environment, was performed. RESULTS Forty-four consecutive patients were included from the day of lung transplantation and then examined weekly for aspergillus colonisation until hospital discharge. Environmental fungal contamination of each patient was followed weekly via air and surface sampling. Twelve patients (27%) had transient aspergillus colonisation, occurring 1-13 weeks after lung transplantation, without associated manifestation of aspergillosis. Responsible Aspergillus species were A. fumigatus (6), A. niger (3), A. sydowii (1), A. calidoustus (1) and Aspergillus sp. (1). In the environment, contamination by Penicillium and Aspergillus was predominant. Multivariate analysis showed a significant association between occurrence of aspergillus colonisation and fungal contamination of the patient's room, either by Aspergillus spp. in the air or by A.fumigatus on the floor. Related clinical and environmental isolates were genotyped in 9 cases of aspergillus colonisation. For A. fumigatus (4 cases), two identical microsatellite profiles were found between clinical and environmental isolates collected on distant dates or locations. For other Aspergillus species, isolates were different in 2 cases; in 3 cases of aspergillus colonisation by A. sydowii, A. niger and A. calidoustus, similarity between clinical and environmental internal transcribed spacer and tubulin sequences was >99%. CONCLUSION Taken together, these results support the hypothesis of environmental risk of hospital acquisition of aspergillus colonisation in lung transplant recipients.
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Affiliation(s)
- Christine Bonnal
- AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, F-75018, Paris, France
| | - Christopher Leleu
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
- University Pierre et Marie Curie-Paris 6, Paris, France
| | - Olivier Brugière
- AP-HP, Service de Pneumologie B, Unité de Transplantation Pulmonaire, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
| | - Christian Chochillon
- AP-HP, Laboratory of Parasitology and Mycology, Bichat-Claude Bernard University Hospital, Paris, France
| | - Raphael Porcher
- Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité, UMR 1153, Inserm, Université Paris Descartes, Paris, France
| | - Pierre-Yves Boelle
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique–U1136, Paris, France
| | - Jean Menotti
- AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, F-75018, Paris, France
- AP-HP, Laboratory of Parasitology and Mycology, Saint-Louis University Hospital, Paris, France
| | - Sandrine Houze
- AP-HP, Laboratory of Parasitology and Mycology, Bichat-Claude Bernard University Hospital, Paris, France
- UMR 216, Mère et enfants face aux infections tropicales, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Paris, France
| | - Jean-Christophe Lucet
- University Pierre et Marie Curie-Paris 6, Paris, France
- Paris Diderot University, IAME, UMR 1137, F-75018 Paris, France
| | - Francis Derouin
- AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, F-75018, Paris, France
- AP-HP, Laboratory of Parasitology and Mycology, Saint-Louis University Hospital, Paris, France
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Maxwell BG, Mooney JJ, Lee PHU, Levitt JE, Chhatwani L, Nicolls MR, Zamora MR, Valentine V, Weill D, Dhillon GS. Increased resource use in lung transplant admissions in the lung allocation score era. Am J Respir Crit Care Med 2015; 191:302-8. [PMID: 25517213 DOI: 10.1164/rccm.201408-1562oc] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
RATIONALE In 2005, the lung allocation score (LAS) was implemented to prioritize organ allocation to minimize waiting-list mortality and maximize 1-year survival. It resulted in transplantation of older and sicker patients without changing 1-year survival. Its effect on resource use is unknown. OBJECTIVES To determine changes in resource use over time in lung transplant admissions. METHODS Solid organ transplant recipients were identified within the Nationwide Inpatient Sample (NIS) data from 2000 to 2011. Joinpoint regression methodology was performed to identify a time point of change in mean total hospital charges among lung transplant and other solid-organ transplant recipients. Two temporal lung transplant recipient cohorts identified by joinpoint regression were compared for baseline characteristics and resource use, including total charges for index hospitalization, charges per day, length of stay, discharge disposition, tracheostomy, and need for extracorporeal membrane oxygenation. MEASUREMENTS AND MAIN RESULTS A significant point of increased total hospital charges occurred for lung transplant recipients in 2005, corresponding to LAS implementation, which was not seen in other solid-organ transplant recipients. Total transplant hospital charges increased by 40% in the post-LAS cohort ($569,942 [$53,229] vs. $407,489 [$28,360]) along with an increased median length of stay, daily charges, and discharge disposition other than to home. Post-LAS recipients also had higher post-transplant use of extracorporeal membrane oxygenation (odds ratio, 2.35; 95% confidence interval, 1.56-3.55) and higher incidence of tracheostomy (odds ratio, 1.52; 95% confidence interval, 1.22-1.89). CONCLUSIONS LAS implementation is associated with a significant increase in resource use during index hospitalization for lung transplant.
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Affiliation(s)
- Bryan G Maxwell
- 1 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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