Materiały źródłowe

• #1 Data and Statistics on Aspergillosis | Aspergillosis | CDC

  https://www.cdc.gov/aspergillosis/statistics/index.html

  Aspergillosis is not a reportable disease in the United States, so the exact number of cases is difficult to determine. […] Because aspergillosis is not a reportable infection in the United States, the exact number of cases is difficult to determine. Milder, allergic forms of aspergillosis are more common than the invasive form of the infection. […] The first population-based incidence estimates for invasive aspergillosis were obtained from laboratory surveillance conducted in the San Francisco Bay Area during 1992-1993 and suggested a yearly rate of 1 to 2 cases of aspergillosis per 100,000 population. […] Prospective surveillance among transplant recipients performed during 2001-2006 found that invasive aspergillosis was the most common type of fungal infection among stem cell transplant recipients and was the second-most common type of fungal infection among solid organ transplant recipients.

• #2 Aspergillosis – Wikipedia

  https://en.wikipedia.org/wiki/Aspergillosis

  Aspergillosis is thought to affect more than 14 million people worldwide, with allergic bronchopulmonary aspergillosis (ABPA) infecting about 4 million, severe asthma with fungal sensitization affecting about 6.5 million, and chronic pulmonary aspergillosis (CPA) infecting about 3 million people, considerably more than invasive aspergillosis which affects about 300,000 people.[40] […] A systematic review has evaluated the diagnostic accuracy of polymerase chain reaction (PCR) tests in people with defective immune systems from medical treatment such as chemotherapy.[30] Evidence suggests PCR tests have moderate diagnostic accuracy when used for screening for invasive aspergillosis in high risk groups.[30]

• #3 Aspergillosis: Epidemiology, Diagnosis, and Treatment – PubMed

  https://pubmed.ncbi.nlm.nih.gov/34016284/

  The spectrum of disease produced by Aspergillus species ranges from allergic syndromes to chronic pulmonary conditions and invasive infections. Invasive aspergillosis is a major cause of morbidity and mortality in immunocompromised patients. Risk factors continue to evolve and include newer biological agents that target the immune system and postinfluenza infection; and it has been observed following COVID-19 infection. […] Invasive pulmonary aspergillosis / epidemiology […] Invasive pulmonary aspergillosis is a major cause of morbidity and mortality in immunocompromised patients.

• #4 Aspergillosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482241/

  Invasive aspergillosis overwhelmingly affects the immunocompromised population, composed of patients with AIDS, those with hematologic malignancies, prolonged neutropenia, long-term corticosteroids, and recipients of transplants on anti-rejection medications. […] Around 250,000 cases of invasive aspergillosis are estimated to occur globally yearly. […] The incidence of invasive aspergillosis in hospitalized patients rose by 44% between 2004 and 2013. […] Patients with underlying lung diseases such as chronic obstructive lung disease, tuberculosis, asthma, lung cancer, and sarcoidosis are at risk for developing the chronic form of aspergillosis. […] Those working in the construction, farming industries, and wastewater treatment plants may be at increased risk of Aspergillus infection due to chronic exposure in their work environments. […] Nosocomial Aspergillus infections have been reported from hospital showers and healthcare facilities undergoing construction.

• #5 Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0722-7

  In this cohort of 563 patients with an Aspergillus-positive cultures, 53% were diagnosed with putative or proven IA. Compared with patients with Aspergillus colonization, more patients with IA had cancer, organ transplant or sepsis and/or ARDS on admission, and more needed supportive therapy. […] The true epidemiology of IA remains uncertain and depends on case mix, environmental factors and diagnostic strategy. […] Few studies have been done on the epidemiology of IA in ICUs. […] In our study, we found a higher proportion of proven and putative IA cases with positive GM levels (both 84%), as compared with only 18% in patients with Aspergillus colonization. […] In our present study, patients with putative and proven IA had significantly higher mortality rates than patients with Aspergillus colonization; however, after adjustment for several confounders, this difference remained significant only for patients with proven IA.

• #6 Diagnosis of invasive pulmonary aspergillosis in the intensive care unit: what we should concern and how to do better – Shen – Journal of Emergency and Critical Care Medicine

  https://jeccm.amegroups.org/article/view/5450/html

  Invasive pulmonary aspergillosis (IPA) may lead to fatal illness if timely diagnosis and appropriate management is not done. […] It cannot be denied that IPA has been on the rise in the ICU during the last two decades due to the increased number of immunocompromised hosts admitted and the application of invasive treatment procedures. […] However, data regarding the incidence of IPA in the ICU is limited and IPA diagnosis accurately is a quite challenging job, because of the non-specific symptoms or signs, which may lead to the misdiagnosis of bacterial pneumonia or even non-infectious diseases. […] The incidence of IPA in ICU ranges from 0.3% to 5.8%, and the overall mortality rate is over 80%. […] The classis risk factor known as neutropenia was only observed in 10%-15% ICU patients while other factors were recognized in nonneutropenic ICU patients these years.

• #7 ASPERGILLOSIS | Harrison’s Manual of Medicine

  https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623284/all/ASPERGILLOSIS?q=DIARRHEA

  Aspergillus, a mold with septate hyphae branching at 45 angles, has vast numbers of conidia (spores). It has a worldwide distribution and typically grows in decomposing plant materials and in bedding. A. fumigatus is responsible for most cases of invasive aspergillosis, almost all cases of chronic aspergillosis, and most allergic syndromes. […] Inhalation is common; only intense exposures cause disease in healthy, immunocompetent individuals. […] The primary risk factors for invasive aspergillosis are profound neutropenia, glucocorticoid use, therapy with immune modulators (e.g., TNF- inhibitors, ibrutinib), severe liver disease, influenza infection, and extracorporeal membrane oxygenation therapy. […] Pts with chronic pulmonary aspergillosis have a wide spectrum of underlying pulmonary diseases (e.g., tuberculosis, sarcoidosis).

• #8 Routine Surveillance of Healthcare-Associated Infections Misses a Significant Proportion of Invasive Aspergillosis in Patients with Severe COVID-19

  https://www.mdpi.com/2309-608X/8/3/273

  Rates of invasive aspergillosis (IA) among COVID-19 ICU patients seem to reach over 30% in certain settings. […] Although reports on IA rates among COVID-19 ICU patients vary, some authors have reported rates of over 30%. […] The Centers for Disease Prevention and Control (CDC) recommend increased awareness regarding IA in patients with severe COVID-19, particularly in those who remain febrile even after a course of adequate antibiotic treatment against bacterial co-infections. […] Even though all ICU patients at VGH are under continuous surveillance for healthcare-associated infections (HAI) according to the European Centers of Disease Prevention and Control (ECDC) HAI-Net ICU protocol (including different types of pneumonia), we were concerned that this protocol alone might not be sufficient for IA detection as it is mainly focused on bacterial infections.

• #9 Aspergillosis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/960938-overview

  Although allergy to Aspergillus, as manifested by a positive skin test reaction to Aspergillus antigen, is present in approximately 25% of people with asthma and 50% of patients with CF, ABPA is much less common. From surveys and an ABPA registry, 0.25-0.8% of people with asthma and approximately 7% of patients with CF are estimated to have ABPA. The incidence of ABPA in people with asthma who are steroid-dependent or have associated central bronchiectasis is higher, estimated at 7-10%. […] The frequency of invasive aspergillosis reflects disease states and treatments that result in prolonged neutropenia and immunosuppression. Invasive aspergillosis is estimated to occur in 5-13% of recipients of bone marrow transplants, 5-25% of patients who have received heart or lung transplants, and 10-20% of patients who are receiving intensive chemotherapy for leukemia. Although it has been described in individuals who are immunocompetent, invasive aspergillosis is exceedingly uncommon in this population. […] The incidence of ABPA among people with asthma appears to be higher in Great Britain than in the United States. […] The age distribution of aspergillosis is consistent with that of the various comorbid conditions with which it is associated.

• #10 Aspergillosis epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Aspergillosis_epidemiology_and_demographics

  The true incidence of aspergillosis is unknown since aspergillosis is not a reportable disease in the USA. […] The annual incidence of allergic bronchopulmonary aspergillosis is estimated to be 5 million cases worldwide. […] In contrast, invasive aspergillosis is much less common with an incidence of approximately 1 to 2 cases per 100,000 individuals. […] Invasive aspergillosis is the most common type of fungal infection among stem cell transplant recipients (5% to 10%) and the second most common type of fungal infection among solid organ transplant recipients (5% to 25%). […] With the advancement of immunosuppressive therapy and higher rates of transplantation, the incidence and detection of aspergillosis is increasing in developed countries.

• #11 Data and Statistics on Aspergillosis | Aspergillosis | CDC

  https://www.cdc.gov/aspergillosis/statistics/index.html

  Most cases of aspergillosis are sporadic and are not part of an outbreak. Invasive aspergillosis outbreaks often occur with hospital construction or renovation, which can increase the amount of airborne Aspergillus. Outbreaks can also result from the use of contaminated medical devices. […] In a systematic review of intensive care unit autopsy studies, aspergillosis was one of the top four most common diagnoses that likely lead to death.

• #12 Clinical Practice Guideline for the Diagnosis and Management of Aspergillosis: 2016 Update by IDSA

  https://www.idsociety.org/practice-guideline/aspergillosis/

  Aspergillus species continue to be an important cause of life-threatening infection in immunocompromised patients. This at-risk population is comprised of patients with prolonged neutropenia, allogeneic hematopoietic stem cell transplant (HSCT), solid organ transplant (SOT), inherited or acquired immunodeficiencies, corticosteroid use, and others. […] Leukemia and transplant centers should perform regular surveillance of cases of invasive mold infection. An increase in incidence over baseline or the occurrence of invasive mold infections in patients who are not at high risk for such infections should prompt evaluation for a hospital source (strong recommendation; low-quality evidence). […] Hospitalized allogeneic HSCT recipients should be placed in a protected environment to reduce mold exposure (strong recommendation; low-quality evidence). These precautions can be reasonably applied to other highly immunocompromised patients at increased risk for IA, such as patients receiving induction/reinduction regimens for acute leukemia (strong recommendation; low-quality evidence). […] What Are Sources of Exposure to Aspergillus, and How Can Exposure Be Decreased? Is Environmental Surveillance Useful?

• #13 Invasive Aspergillosis by Aspergillus flavus: Epidemiology, Diagnosis, Antifungal Resistance, and Management

  https://www.mdpi.com/2309-608X/5/3/55

  A. flavus has been demonstrated to differ from A. fumigatus in terms of geographical distribution, pathogenic potential and antifungal resistance profile. […] Hospital outbreaks due to A. flavus have been reported mainly in immunocompromised patients and they present as invasive pulmonary, sinus, or other forms. […] In a large review of nosocomial outbreaks of aspergillosis, A. fumigatus was the most common (n = 154 patients) species implicated followed by A. flavus (n = 101 patients). […] The major organs involved during fungal outbreaks in hospitals were only lung (46%) followed by lung with other sites (20%), skin/wound (7%), sinus with other sites, eye, and disseminated multi-organ disease. […] The overall mortality rate was 58%, and the source of outbreaks in the majority of cases was attributed to construction, renovation, or demolition work in the hospital.

• #14 The Changing Epidemiology of Invasive Aspergillosis in the Non-Traditional Host: Risk Factors and Outcomes

  https://www.oatext.com/The-Changing-Epidemiology-of-Invasive-Aspergillosis-in-the-Non-Traditional-Host-Risk-Factors-and-Outcomes.php

  Invasive fungal infections due to Aspergillus spp. are common in high-risk immunocompromised patients. Recently, invasive aspergillosis (IA) in the low-risk or non-traditional host has been increasingly recognized. […] The true incidence of IA in these low-risk or non-traditional hosts is frequently underestimated due to a low index of suspicion, a lack of consistent case definitions, absence of surveillance measures and a low sensitivity of current diagnostic assays. […] This study describes IA in a population infrequently studied and considered to be at low risk when compared to the neutropenic population of patients. Awareness of risk factors in this non-traditional host, improved diagnostic techniques, and earlier initiation of appropriate antifungal therapy should improve overall survival and response to therapy. Larger, multicenter epidemiologic studies in similar populations are warranted to improve the understanding of this underestimated infection.

• #15 Hospital Epidemiologic Surveillance for Invasive Aspergillosis: Patient Demographics and the Utility of Antigen Detection | Infection Control & Hospital Epidemiology | Cambridge Core

  https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/hospital-epidemiologic-surveillance-for-invasive-aspergillosis-patient-demographics-and-the-utility-of-antigen-detection/56E29F608B745F02A43FBAA9F3C00392

  To monitor the epidemiology of invasive aspergillosis at a university hospital during a period of hospital construction. […] Hospital surveillance for aspergillosis should include determination of whether cases are nosocomial or community-acquired, because many may be the latter. […] Enhanced case detection occurred with active surveillance of patients considered to be at risk using both fungal serology and traditional microbiological techniques. […] Antigen detection was more sensitive and specific for the detection of invasive aspergillosis and may improve epidemiological surveillance for aspergillosis.

• #16 Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0722-7

  Invasive aspergillosis (IA) is a fungal infection that particularly affects immunocompromised hosts. Recently, several studies have indicated a high incidence of IA in intensive care unit (ICU) patients. However, few data are available on the epidemiology and outcome of patients with IA in this setting. […] Although IA has been considered a rare condition among critically ill patients, recent data indicate that it should be reconsidered as an emerging and devastating infectious disease in this population. […] In clinical practice, a diagnosis of IA is frequently suspected when Aspergillus is isolated from non-sterile body sites, particularly tracheal and bronchial aspirates. […] The aim of this study was therefore to collect data from a large series of ICU patients with either Aspergillus colonization or invasive disease in order to investigate the epidemiology of IA in this population.

• #17 Invasive Aspergillosis by Aspergillus flavus: Epidemiology, Diagnosis, Antifungal Resistance, and Management

  https://www.mdpi.com/2309-608X/5/3/55

  Aspergillus flavus is the second most common etiological agent of invasive aspergillosis (IA) after A. fumigatus. […] Infection due to A. flavus is predominant in Asia, the Middle East and Africa possibly due to its better ability to survive in hot and arid climatic conditions compared to other Aspergillus spp. […] The present review aimed to update the available literature on the epidemiology, antifungal resistance, diagnosis, and management of IA due to A. flavus. […] Climatic and geographic conditions may be important determinants of the local prevalence and distribution of Aspergillus species. A. flavus is more prevalent in the environment of some tropical countries like India, Mexico, Pakistan, Sudan, and Saudi Arabia and consequently remains the most frequent species causing aspergillosis in those countries.

• #18 Killer Fungus Threat in the UK: Learn the Risks & Protect Yourself Now!

  https://stories.jobaaj.com/news-updates/world/killer-fungus-threat-in-the-uk-learn-the-risks-protect-yourself-now

  Climate change is fueling the spread of deadly fungi like *Aspergillus* and drug-resistant *Candida auris* in the UK, posing a serious public health threat requiring urgent research and action. […] Studies indicate that rising global temperatures are expanding Aspergillus’s habitat northward. One species, Aspergillus fumigatus, could spread to an additional 77% of territory by 2100 under a high-emissions scenario, potentially exposing an extra nine million people in Europe to infection. […] Health officials are taking steps to address this growing threat. This includes increased surveillance, improved diagnostic tools, and efforts to develop new antifungal treatments. However, the scale of the problem underscores the critical need for more research and resources to combat this emerging public health crisis.

• #19 The Silent Siege: How Climate Change is Fueling a Fungal Crisis in Europe – Policy Wire

  https://policy-wire.com/the-silent-siege-how-climate-change-is-fueling-a-fungal-crisis-in-europe/

  Aspergillus flavus and Aspergillus fumigatus, across the continent. This expansion is propelled by rising temperatures and changing environmental conditions. […] A study funded by the Wellcome Trust and led by Norman van Rhijn at the University of Manchester reveals that the distribution of A. flavus could increase by 16 percent, potentially exposing an additional one million people in Europe to its effects. Even more concerning is the projected 77.5 percent expansion of A. fumigatus, which may put nine million more individuals at risk. […] A. fumigatus, on the other hand, is a common cause of aspergillosis, a respiratory disease that can be fatal, especially in immunocompromised individuals. […] The World Health Organization has already placed A. fumigatus on its list of high-priority pathogens. Yet public awareness remains virtually nonexistent. Mycologists, the scientists who study fungi, are underfunded and understaffed. Surveillance is patchy. […] The fungal threat represents a gaping blind spot in Europes climate resilience and public health preparedness. […] Europe needs a continent-wide fungal surveillance network that integrates environmental, agricultural, and health data in real time.

• #20

  https://link.springer.com/article/10.1007/s12281-023-00459-z

  IA (invasive aspergillosis) caused by azole-resistant strains has been associated with higher clinical burden and mortality rates. […] There is an increase of azole resistance in Aspergillus spp. worldwide, probably due to environmental pressure and the increase of long-term azole prophylaxis and treatment in immunocompromised patients (e.g., in hematopoietic stem cell transplant recipients). […] Continuous surveillance studies to monitor the prevalence of environmental and patient prevalence of azole resistance among Aspergillus spp. is absolutely crucial. […] Azole-resistant A. fumigatus (ARAF) strains caused by the mutations TR34/L98H or TR46/Y121F/T289A have been reported worldwide. […] Due to variability in agricultural use of azole-containing pesticides, scarce routine surveillance programs, and limited availability of routine susceptibility testing, there is a lack of relevant, detailed epidemiological data.

• #21

  https://link.springer.com/article/10.1007/s12281-023-00459-z

  The Netherlands have reported one of the highest ARAF-prevalence in Europe, with a significant increase from 1.76% in the period 19972007 to 815% between 2013 and 2018. […] In Denmark, ARAF prevalence was reported to be 6.1%, based on a national surveillance program between 2018 and 2020. […] In Spain, the estimated prevalence is between 1.2 and 6.6%. […] In the USA, the first reported TR34/L98H mutation was reported in 2016. […] In the African continent, data are also limited. Some data are suggesting ARAF prevalence of 1.3% in clinical samples and up to 17.1% in the environmental setting. […] Rapid detection of azole resistance is fundamental, since infections caused by these strains are associated with higher mortality, between 88 and 100%. […] Comparative studies between azole resistant and susceptible strains of Aspergillus spp. in IA showed a 2131% higher mortality in the azole resistant group.

• #22 Invasive Aspergillosis: epidemiology, diagnosis and management in immunocompromised patients. – Document – Gale Academic OneFile

  https://go.gale.com/ps/i.do?id=GALE%7CA200507190&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=00126667&p=AONE&sw=w

  Morbidity and mortality caused by invasive Aspergillus infections are increasing. […] Strict reverse isolation appears to reduce the incidence of aspergillosis in allogeneic stem cell transplant recipients and patients with acute myeloid leukaemia undergoing aggressive anticancer therapy. […] Prophylactic systemic antifungal treatment with posaconazole significantly improves survival and reduces IA in acute myeloid leukaemia patients and reduces aspergillosis incidence rates in patients with intermediate-to-severe graft-versus-host reaction emerging after allogeneic haematopoietic stem cell transplantation. […] Voriconazole prophylaxis may be suitable for prevention of IA as well; however, the results of large clinical trials are still awaited.

• #23 Epidemiology of Aspergillosis in Patients with Cancer:Taiwan | IDR

  https://www.dovepress.com/epidemiology-of-aspergillosis-in-cancer-patients-in-taiwan-peer-reviewed-fulltext-article-IDR

  The incidence of aspergillosis is increasing, and the risk factors for infection include cancer, admission to the intensive care unit, chronic pulmonary diseases, immunocompromised status, and taking immunomodulatory drugs. […] The aim of our study was to survey the incidence of aspergillosis in different cancer types from 2006 to 2017. […] The overall incidence rates of aspergillosis tended to increase significantly from 2006 to 2017 (from 3.50 to 13.37 per 10,000 person-years, p value: 0.001). […] The incidence of aspergillosis was increased in cancer patients, and cancer patients with aspergillosis had a significantly higher risk of mortality than those without aspergillosis. […] There is an increasing incidence of invasive pulmonary aspergillosis in Taiwan for males from 0.87 to 4.55 per million person-years and females from 0.36 to 2.07 per million person-years between 2002 and 2011. […] The overall incidence rate of aspergillosis was 13.57 per 10,000 person-years in cancer patients, and it is important for physicians to be aware of aspergillosis, so that they can make a prompt diagnosis and begin early treatment in cancer patients.

• #24

  https://link.springer.com/article/10.1007/s40121-020-00331-4

  The association between genetic background and the risk of invasive aspergillosis (IA) has not been addressed in Thailand. We conducted genetic risk surveillance for IA among Thai hematologic patients. […] Genetic surveillance for risk stratification of IA is a logical step to identify patients at risk and potentially assist clinicians to design more intensive monitoring and to more specifically select anti-mold prophylaxis. […] The primary objective of this study was to analyze the potential genetic predisposition to IA among moderate- to high-risk hematology patients. The secondary objectives were to study the epidemiology of IA and the potential impact of genetic predisposition on clinical outcomes related to IA. […] Data on the epidemiology of IA in Thailand are limited, with only a few retrospective studies conducted but none in hematology patients.

• #25 Epidemiology and Clinical Characteristics of Invasive Pulmonary Aspergillosis in Korea: Tasks for the Future

  https://pc.icjournal.org/search.php?where=aview&id=10.3947/ic.2012.44.4.328&code=0086IC&vmode=PUBREADER

  Invasive pulmonary aspergillosis (IPA) is a leading cause of morbididy and mortality for patients with malignancy and transplantation recipients. […] Because the epidemiologies of invasive fungal infections would differ between Korea and Western countries, Organization of a nationwide network in collaboration with infectious diseases specialists, medical microbiologists, and government personnels is also anticipated. […] Epidemiology and clinical outcomes of invasive pulmonary aspergillosis: a nationwide multicenter in Korea.

• #26 Routine Surveillance of Healthcare-Associated Infections Misses a Significant Proportion of Invasive Aspergillosis in Patients with Severe COVID-19

  https://www.mdpi.com/2309-608X/8/3/273

  We conducted an observational study on the incidence of IA in COVID-19 patients admitted to the ICU and retrospectively compared four diagnostic algorithms based on different recommendations for the diagnosis of IA as an add-on to our routine surveillance protocol. […] Using the most sensitive algorithm, 9.9% (n = 25/252) of all COVID-19 patients admitted to VGH’s intensive care units from March 2020 to July 2021 developed IA. […] Only seventeen out of 25 probable or possible cases of IA were detected when applying routine surveillance according to the ECDC 2017 protocol, which aims primarily at the detection of infections caused by classical nosocomial pathogens such as S. aureus, enterobacterales and nonfermenting gram-negatives. […] From an infection prevention and control perspective, for the surveillance of IA in a highly vulnerable patient cohort, such as patients with severe COVID-19, applying an algorithm especially designed for respiratory viral illness seems useful.

• #27

  https://link.springer.com/article/10.1007/s40121-020-00331-4

  Genetic predisposition to IA has been increasingly studied over the past decade, mostly in North America and Europe. […] This reflects that patients with AML undergoing chemotherapy may be an appropriate group in which to consider antifungal prophylaxis when the cost of the antifungal agent is a concern. […] Genetic surveillance of patients at risk, particularly those with AML, and considering antifungal prophylaxis with IL10rs1800896 C carriage is recommended, especially when universal antifungal prophylaxis is not an option. […] Apart from traditional clinical risk factors, polymorphisms of immunoregulatory gene IL10rs1800896 may be an important risk factor to consider in risk stratification of IA development, particularly in patients with AML.

• #28 Five-years surveillance of invasive aspergillosis in a university hospital | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-11-163

  As the most common invasive fungal infection, invasive aspergillosis (IA) remains a serious complication in immunocompromised patients, leading to increased mortality. 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. The IA incidence in organ transplant recipients may be as high as 5%; mortality rates of up to 80% have been reported. Thus, the Centers for Disease Control and Prevention (CDC) recommend the need for surveillance of pulmonary IA in hospitals. The aim of the five year surveillance study presented here was to obtain an overview of IA cases in the entire university hospital using a standardized surveillance method. Our data show that IA may occur in all types of medical departments, and in all kinds of patients with severe underlying diseases. Our findings therefore implicate that IA surveillance needs to be extended and should comprise the entire hospital including all high risk units. Thus, our study emphasizes the importance of IA surveillance, not just in hematology units; rather, surveillance should be expanded to cover all high-risk units (ICUs, respiratory care, infectious diseases and internal medicine units, in particularly). This study provides an overview on the incidence of IA cases in a university hospital through use of a standardized surveillance system. One should keep in mind that so-called „high risk” patients for IA are not only those undergoing transplantation, but all other patients receiving immunosuppressive therapy. Thus, this type of surveillance approach should be performed hospital-wide and should include all patients that are potentially at increased risk of IA.

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