Invasive Pulmonary Aspergillosis: Risks for Acquisition and Death in a Community Hospital

Background: Recent cases of hospital-acquired (HA) aspergillosis on our Trauma Service raised the question of whether this represented an outbreak or just increased case identification.

Patients and methods: After Institutional Review Board approval, we performed a retrospective analysis of all 117 patients with positive pulmonary Aspergillus cultures at Grand Strand Medical Center from 2010 through 2016. The diagnosis of community-acquired (CA) invasive pulmonary aspergillosis (IPA) was determined when patients were admitted with a pneumonia and the diagnosis was made within the first week of hospitalization.

Results: Of patients with fungus cultures (3929), 3% (117) were positive for Aspergillus. More than 70% (84) of patients were colonized. The remaining 33 patients were treated for IPA. Twenty-seven patients had chronic respiratory problems and presented with a new lower respiratory illness; 23 had CA IPA diagnosed within the first week of admission with 17% mortality rate; four patients had a delayed diagnosis (probable CA) with a 75% mortality rate. The six remaining patients all underwent a surgical procedure and were suspected to have HA aspergillosis. There was a significantly higher rate of HA in the surgical subset in comparison with all nonsurgical patients (p < 0.03). Patients treated for IPA were more likely to be receiving high dose prednisone (>20 mg/day, p < 0.004) and their mortality rate was significantly higher than colonized patients (27.3% vs. 9.5%, p < 0.026). Patients with HA IPA were divided evenly over the years of the study period and not thought to represent an outbreak.

Conclusions: Aspergillus infection is an endemic infection in this region of the southern Atlantic states and may occur in patients with major trauma as well as patients with chronic pulmonary diseases. Our data support the concept that there were no breaches in air quality to cause the IPA. Aggressive fungal therapy should be considered in all at-risk patients.