Pathogenic molds (includingAspergillusspecies) in hospital water distribution systems: a 3-year prospective study and clinical implications for patients with hematologic malignancies

• Published in: Blood 2003-04, Vol.101 (7), p.2542-2546
• Main Authors: Anaissie, Elias J., Stratton, Shawna L., Dignani, M. Cecilia, Lee, Choon-kee, Summerbell, Richard C., Rex, John H., Monson, Thomas P., Walsh, Thomas J.
• Format: Article
• Language: English
• Subjects: Air Microbiology; Aspergillus - isolation & purification; Aspergillus - pathogenicity; Biological and medical sciences; Bone Marrow Transplantation - adverse effects; Chlorine - analysis; Collective facilities; Environment. Living conditions; Fungi - isolation & purification; Fungi - pathogenicity; Hematologic and hematopoietic diseases; Hematologic Neoplasms - complications; Hospitals - standards; Humans; Immunocompromised Host; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Medical sciences; Mycoses - etiology; Mycoses - transmission; Opportunistic Infections - transmission; Public health. Hygiene; Public health. Hygiene-occupational medicine; Water Microbiology; Water Supply - standards
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2002-02-0530

The incidence of mold infections in patients with hematologic malignancies continues to increase despite the widespread use of air filtration systems, suggesting the presence of other hospital sources for these molds. Water sources are known to harbor pathogenic molds. We examined samples from water, water surfaces, air, and other environment sources from a bone marrow transplantation unit with optimal air precautions. Molds (Aspergillusspecies, others) were recovered in 70% of 398 water samples, in 22% of 1311 swabs from plumbing structures and environmental surfaces, and in 83% of 274 indoor air samples. Microscopic examination of the water plumbing lines revealed hyphal forms compatible with molds. Four findings suggest that indoor airborne molds were aerosolized from the water: (1) higher mean airborne concentrations of molds in bathrooms (16.1 colony-forming units [CFU]/m3) than in patient rooms (7 CFU/m3) and hallways (8.6 CFU/m3;P =.00005); (2) a strong type and rank correlation between molds isolated from hospital water and those recovered from indoor hospital; (3) lack of seasonal correlation between the airborne mold concentration in outdoor and indoor air; and (4) molecular relatedness between a clinical strain and a water-related strain (previously reported). Hospital water distribution systems may serve as a potential indoor reservoir ofAspergillusand other molds leading to aerosolization of fungal spores and potential exposure for patients.