THURSDAY, Nov. 7, 2002 (HealthDayNews) -- While the spotlight has been focused on the dangers of hospital-acquired infections from resistant bacteria, fungal infections have also been making silent and deadly inroads.
This is part of the dark side of advances in medical technology: Yeast and mold infections that can invade the blood stream via a contaminated catheter or simply by breathing the air around you.
The rate of invasive aspergillosis, which is caused by a fungus called Aspergillus, is 5 percent to more than 20 percent in high-risk groups, including people with compromised immune systems, such as HIV patients, cancer patients and organ transplant recipients.
According to the U.S. Centers for Disease Control and Prevention (CDC), Aspergillus is found throughout the environment -- in soil, decomposing plant matter, household dust, building materials and ornamental plants, as well as food and water.
"It's like bread mold. You will see it in the shower or eating in your house or in your refrigerator. We all breathe it in," says Dr. Thomas Patterson, a professor of medicine at the University of Texas Health Science Center at San Antonio.
The problem is treating it. Particularly in the high-risk groups, who are prone to infection while hospitalized.
"We were faced with a kind of double dilemma," Patterson admits. "On one hand, infections had increased dramatically in numbers because of what we're doing to patients to make them live longer, but most of our therapies were in the dark ages. The therapy we use for this disease was developed in the late 1950s."
That therapy is a drug called amphotericin B.
However, a new drug has been shown to be more effective and was approved by the U.S. Food and Drug Administration earlier this year for the treatment of aspergillosis. A randomized study published recently in The New England Journal of Medicine showed that voriconazole -- or VFEND -- was superior to amphotericin B.
At 12 weeks after the start of treatment, the survival rate in the voriconazole group was almost 71 percent, while the survival rate in the amphotericin B group was just under 58 percent. VFEND also has fewer side effects.
"The results were striking. They showed that the new drug prolonged survival in a dramatic fashion. One in seven getting the new drug survived that would have died," says Patterson, who was one of the lead U.S. investigators in this multi-nation trial.
"This is the first time that any drug compared to the standard therapy had shown better survival," he adds. "It's also pretty remarkable that these are very sick patients who have a lot of other complications, so to show better survival is quite an achievement."
However exciting the drug results are, some feel they're only a Band-aid on the much larger problem of combating hospital-acquired infections.
"My own view here is that fungal infections are a minor subgroup of the bigger problem," says Dr. Robert Haley, a professor of internal medicine and chief of epidemiology at the University of Texas Southwestern Medical Center in Dallas. Hospital-acquired infections affect anywhere from 2 percent to 10 percent of hospital patients, a large number by any standard.
The underlying problem, says Haley, is that "managed care and budget cuts are preventing hospitals from investing in computer surveillance of infection, and feedback of infection rates to doctors and nurses to reduce the problem."
While the tools to control hospital infections are out there, they're underutilized, Haley says.
In particular, Haley is referring to techniques studied and recommended by the CDC in the 1980s. One technique was an ongoing program to monitor the rates of the most important types of infections to determine if the rates were increasing or decreasing.
In fact, the CDC has had a benchmarking program for the past 30 years in which about 70 hospitals report their infection rates so other hospitals can make comparisons. Seems simple enough but few hospitals, perhaps no more than 25 percent or 30 percent, are taking advantage of it.
The techniques studied by the CDC showed, on average, a 32 percent reduction in serious hospital-acquired infections.
The most essential and most expensive part of any infection-control system is the personnel. Factor in managed care and budget cuts, and you have at least part of the reason why doctors of different stripes say they are talking these days about formerly arcane topics such as aspergillosis.
Patterson jokes that, once upon a time, the only people who knew about fungal disease were the ones who stayed awake for the last two minutes of class.
"A few years ago, aspergillosis was a weird thing to talk about," he says. "But it has gotten a lot of attention in recent years because of its importance in high-risk populations. It's not something that can be relegated to a few specialized doctors."
What To Do
For more information on hospital-acquired infections, visit the U.S. Centers for Disease Control and Prevention. To learn more about aspergillosis, check the National Library of Medicine.
