Association of hospital construction with the development of healthcare associated environmental mold infections (HAEMI) in pediatric patients with leukemia

Hanumantha R. Pokala, David Leonard, Jennifer Cox, Pat Metcalf, John Mcclay, Jane Siegel, Naomi Winick

Research output: Contribution to journalArticle

16 Citations (Scopus)

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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)276-280
Number of pages5
JournalPediatric Blood and Cancer
Volume61
Issue number2
DOIs
StatePublished - Feb 2014

Fingerprint

Hospital Design and Construction
Leukemia
Fungi
Pediatrics
Delivery of Health Care
Infection
Neutropenia
Mycoses
Yeasts
Drug Therapy
Guidelines
Sodium Glutamate
Child Mortality
Fungal Spores
Cross Infection

Keywords

  • Acute leukemia
  • Hospital construction
  • Mold infections
  • Pediatric oncology

ASJC Scopus subject areas

  • Oncology
  • Pediatrics, Perinatology, and Child Health
  • Hematology

Cite this

Association of hospital construction with the development of healthcare associated environmental mold infections (HAEMI) in pediatric patients with leukemia. / Pokala, Hanumantha R.; Leonard, David; Cox, Jennifer; Metcalf, Pat; Mcclay, John; Siegel, Jane; Winick, Naomi.

In: Pediatric Blood and Cancer, Vol. 61, No. 2, 02.2014, p. 276-280.

Research output: Contribution to journalArticle

Pokala, Hanumantha R. ; Leonard, David ; Cox, Jennifer ; Metcalf, Pat ; Mcclay, John ; Siegel, Jane ; Winick, Naomi. / Association of hospital construction with the development of healthcare associated environmental mold infections (HAEMI) in pediatric patients with leukemia. In: Pediatric Blood and Cancer. 2014 ; Vol. 61, No. 2. pp. 276-280.
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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. Conclusion: 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.",
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AB - 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. Conclusion: 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.

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