title: Post-surgical invasive aspergillosis: an uncommon and under-appreciated entity.
abstract: OBJECTIVE
  Post-surgical invasive aspergillosis (PSIA) is an unusual and underestimated complication of surgery. It may occur after colonization of surgical sites by airborne Aspergillus conidia during surgery, or in the immediate postoperative.
  
  
  METHODS
  We reviewed 7 cases of PSIA (1997-2006) and checked the air levels of Aspergillus conidia in the operating rooms and/or areas surrounding 5/7 patients.
  
  
  RESULTS
  PSIA accounted for 8.4% (n = 83) of all cases of invasive aspergillosis. Patients had no classic predisposing conditions (wound infection (n = 4), mediastinitis (n = 2), and endotipsitis with endocarditis (n = 1)). PSIA occurred sporadically after heart, thoracic, and vascular prosthetic surgery. Aspergillus fumigatus was involved in all cases. Median time from surgery to diagnosis was 25 days. Galactomannan was only positive (> or =1 ng/mL) in 2 patients (endotipsitis with endocarditis and mediastinitis). Mortality was 100% in cases of organ/space post-surgical infections. Although the air of operating rooms taken before surgery was free of Aspergillus, airborne Aspergillus conidia levels were high (>95 CFU/m(3)) in the rooms of 2 patients.
  
  
  CONCLUSIONS
  PSIA represented almost 10% of all cases of invasive aspergillosis. Our cases were not linked to high levels of Aspergillus conidia in the operating rooms but to postoperative contamination by environmental isolates present in high counts.
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: Jensen
authors.forename: Jesús
authors.initials: J
authors.lastname: Guinea
authors.forename: Marta
authors.initials: M
authors.lastname: Torres-Narbona
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.forename: Teresa
authors.initials: T
authors.lastname: Peláez
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
mesh_terms: D000368:Aged; D000391:Air Microbiology; D001228:Aspergillosis / Q000453:epidemiology*; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period