title: Five-years surveillance of invasive aspergillosis in a university hospital.
abstract: BACKGROUND
  As the most common invasive fungal infection, invasive aspergillosis (IA) remains a serious complication in immunocompromised patients, leading to increased mortality. Antifungal therapy is expensive and may result in severe adverse effects.The aim of this study was to determine the incidence of invasive aspergillosis (IA) cases in a tertiary care university hospital using a standardized surveillance method.
  
  
  METHODS
  All inpatients at our facility were screened for presence of the following parameters: positive microbiological culture, pathologist's diagnosis and antifungal treatment as reported by the hospital pharmacy. Patients fulfilling one or more of these indicators were further reviewed and, if appropriate, classified according to international consensus criteria (EORTC).
  
  
  RESULTS
  704 patients were positive for at least one of the indicators mentioned above. Applying the EORTC criteria, 214 IA cases were detected, of which 56 were proven, 25 probable and 133 possible. 44 of the 81 (54%) proven and probable cases were considered health-care associated. 37 of the proven/probable IA cases had received solid organ transplantation, an additional 8 had undergone stem cell transplantation, and 10 patients were suffering from some type of malignancy. All the other patients in this group were also suffering from severe organic diseases, required long treatment and experienced several clinical complications. 7 of the 56 proven cases would have been missed without autopsy. After the antimycotic prophylaxis regimen was altered, we noticed a significant decrease (p = 0.0004) of IA during the investigation period (2003-2007).
  
  
  CONCLUSIONS
  Solid organ and stem cell transplantation remain important risk factors for IA, but several other types of immunosuppression should also be kept in mind. Clinical diagnosis of IA may be difficult (in this study 13% of all proven cases were diagnosed by autopsy only). Thus, we confirm the importance of IA surveillance in all high-risk patients.
authors.affiliation: Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Germany. graf.karolin@mh-hannover.de
authors.forename: Karolin
authors.initials: K
authors.lastname: Graf
authors.forename: Somayeh Mohammad
authors.initials: SM
authors.lastname: Khani
authors.forename: Ella
authors.initials: E
authors.lastname: Ott
authors.forename: Frauke
authors.initials: F
authors.lastname: Mattner
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
authors.forename: Dorith
authors.initials: D
authors.lastname: Sohr
authors.forename: Stefan
authors.initials: S
authors.lastname: Ziesing
authors.forename: Iris F
authors.initials: IF
authors.lastname: Chaberny
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D001230:Aspergillus / Q000187:drug effects / Q000276:immunology / Q000302:isolation & purification*; D005858:Germany / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans
chemical_list: D000935:Antifungal Agents