title: Association of hospital construction with the development of healthcare associated environmental mold infections (HAEMI) in pediatric patients with leukemia.
abstract: BACKGROUND
  Healthcare associated mold infections (HAEMI) increase morbidity and mortality in children with leukemia. Excavation adjacent to Children's Medical Center Dallas (CMCD) April 2006-February 2007 provided an opportunity to determine if excavation adjacent to a hospital building is associated with increased risk of developing HAEMI in children receiving intensive chemotherapy for acute leukemia.
  
  
  METHODS
  Children who began receiving intensive chemotherapy for acute leukemia at CMCD from 2004 to 2008 were identified (n = 275). Exposures to the CMCD campus during intensive chemotherapy and duration of neutropenia per exposure were recorded. Proven, probable, or possible invasive fungal disease (IFD) was classified using EORTC/MSG guidelines. Institutional guidelines categorized mold infections as definite or possible HAEMI. A bivariate time-to-event model compared the association of excavation with HAEMI and yeast infections, controlling for neutropenia.
  
  
  RESULTS
  There were 7,454 CMCD exposures, 1,007 (13.5%) during excavation. Of 50 cases of IFD, 31 were HAEMI. By time-to-event analysis exposure to the CMCD campus during the excavation period was significantly associated with HAEMI (HR = 2.8, P = 0.01) but not yeast infections (HR = 0.75, P = 0.75). Neutropenia was significantly associated with both HAEMI and yeast infections (P < 0.001). Voriconazole prophylaxis did not prevent HAEMI in 42% of the 14 patients with AML who had been receiving this agent.
  
  
  CONCLUSIONS
  This study is the first to demonstrate an association between exposure to hospital construction that includes excavation and HAEMI in pediatric oncology patients. Since neutropenic patients need protection from aerosolized fungal spores during visits to expanding medical centers, preventive strategies with adherence monitoring need additional study.
authors: Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors: Hanumantha R
authors: HR
authors: Pokala
authors: David
authors: D
authors: Leonard
authors: Jennifer
authors: J
authors: Cox
authors: Pat
authors: P
authors: Metcalf
authors: John
authors: J
authors: McClay
authors: Jane
authors: J
authors: Siegel
authors: Naomi
authors: N
authors: Winick
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006749:Hospital Design and Construction; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D009181:Mycoses / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D009367:Neoplasm Staging; D009503:Neutropenia / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000935:Antifungal Agents
keywords: acute leukemia; hospital construction; mold infections; pediatric oncology
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