Nosocomial Invasive Fungal Infections:  Johns Hopkins Hospital Definitions for Bone Marrow and Solid Organ Transplant, and Hematologic Malignancy Patients and High Risk Premature Infants

Patient Categories

I.                Bone Marrow Transplant types

Allogeneic

Autologous

II.              Leukemia

Definitions

          Neutropenia:  Absolute neutrophil count (ANC) < 500mm³

          Neutropenia days:  duration of neutropenia will be calculated as number of days from first ANC < 500mm³ or first total WBC< 1000mm³ to  either first ANC/calculated ANC > 500mm³ for first total WBC in normal range (5,000-10,000mm³)

          Nosocomial aspergillosis:  first occurrence of pulmonary or deep, disseminated aspergillosis in a hospitalized patient during the at-risk periods specified below.

Classification criteria nosocomial aspergillosis:

Clinically diagnosed:

Both of the following must be present:

Diagnosis of pulmonary or deep disseminated aspergillosis documented in the patient's medical record by medical staff.  When there is not a clear indication of the diagnosis, consult the attending physician for a definite diagnosis of suspected aspergillosis

Amphotericin dose was > 1mg/kg and a the clinical diagnosis of aspergillosis is documented and receives an appropriate course of therapy

Histologically demonstrated

Pulmonary or deep, disseminated aspergillosis demonstrated by the finding of organisms morphologically consistent with Aspergillus spp. which have invaded deep tissue in biopsy or autopsy specimens

Cases that are both clinically diagnosed and histologically demonstrated will be classified as histologically demonstrated

Onset Date:  the earliest date aspergillosis is first suspected or diagnosed either by CT/CXR, clinical diagnosis or histological diagnosis

Surveillance Mechanisms

In oncology patients,

review weekly CT Scans and CXR's, to look for entries which specify findings consistent with fungal pneumonia or aspergillosis.

 

interview weekly ward staff to request names of patients with possible aspergillosis invasive fungal disease.

Classification of Cases

I.                Nosocomial - an infection acquired in the hospital or health care setting.  These patients do not have an infection that is incubating on admission.  Infection will be considered nosocomial if the patient has been hospitalized for at least one week or discharged less than 2 weeks.

 

II.              Community acquired -  an infection incubating on admission or diagnosed after 2 weeks of discharged. 

 

III.            Undetermined - Unable to distinguish between whether nosocomial and community acquired aspergillosis.

Numerators and Denominators for Infection Rates

I.                Allogeneic BMT

Numerator:  number of allogenic BMT patients with aspergillosis.

At-risk periods:  first 100 days after BMT.  If patient has been discharged for 2 weeks, they must be hospitalized again prior to being at risk.

II.              Autologous BMT

Numerator: Number of Autologous BMT patients with aspergillosis. 

At-risk periods: first 100 days after BMT.  If patient has been discharged for 2 weeks, they must be hospitalized again prior to being at risk.

Denominator:  Number of patients having autologous BMT