Characteristics Of Aspergillus Fumigatus In Flowerpot Soil Of A Hospital In China And The Comparative Study On Prevention And Control Guidelines Of Aspergillosis In Hospital

Objective:The purpose of this research was to investigate the prevalence of azole resistance in A.fumigatus from potting soil samples in the hospital and to explore the genetic relationship between A.fumigatus from the hospital and other sources.This study proves the resolution of TESPERG typing and its prospect of application.Through literature research,the advices in the relevant guidelines for the prevention of aspergillus disease were compared and analyzed to provide advices for the prevention and control of aspergillosis in the hospital.Methods:We collected the soil samples from flowerpots in 18 departments of a hospital from China and isolated A.fumigatus from soil.At the same time,clinical A.fumigatus was collected in laboratory.A.fumigatus isolates was finally identified by growth at 48?and sequencing of the?-tubulin gene.Then conducting the antifungal susceptibility testing for 4 clinical azoles and 7 azole fungicide.All isolates identified as ARAF were subjected for sequencing of cyp51A gene and its promoter.Mating type,TRESPERG typing and STR typing were determined for 174 A.fumigatus.The Simpson's index of diversity?DI?were calculated for TRESPERG typing and STR typing to compare their discriminatory powers.Minimum spanning tree?MST?was constructed based on 174 A.fumigatus isolates by Bionumerics 7.5.Further,we conducted a literature research.We included some international guidelines about infection of aspergillus,including the United States centers for disease control and prevention?CDC?,the American society of infectious diseases?IDSA?,and the European society of clinical microbiology and infectious diseases?ESCMID?.Information related to the prevention and control of aspergillus was extracted,summarized,sorted and compared,and a set of advices for the prevention and control of aspergillus in the hospital was sorted out by comprehensive analysis combined with the latest research progress.Results:A total of 58 samples were collected from potting soil samples in 18 departments of the hospital.Among 106 A.fumigatus obtained,five isolates from 4 soil samples located in the gerontology department were identified as ARAF.Four ARAF harbored TR₃₄/L98H mutation and the other one had no mutation in cyp51A gene.The results of mating type showed that there was no significant difference over the proportions of mating type between the clinical and environment?2=1.477,P=0.224?,the ARAF and azole susceptibility A.fumigatus?2=2.846,P=0.092?according to 174 A.fumigatus.The results of CSP typing showed that t02 was the main CSP type of A fumigatus in the hospital and t11 was the main type of azole resistance A fumigatus in the hospital.Among 174 A.fumigatus selected for genotyping,TRESPERG typing obtained a close discriminatory power?DI=0.9941,95%CI?0.9913,0.9968??compared with the STR typing?DI=0.9997,95%CI?0.9976,1??.Results of genotyping showed that the TR₃₄/L98H isolates in the hospital had a close genetic relationship with ARAF isolates from Shanghai and Fuzhou in China and many other countries such as the Netherlands and Zambia.In the literature research stage,a total of 13 relevant guidelines were retrieved.Comparative studies have shown some differences in the recommendations of different organizations.Through comprehensive analysis,the prevention and control of aspergillosis in the hospital focus on:identifying those patients at high-risk and give them specialized care,put them in the protective environment ward.PE wards are specially designed and managed from engineering and management perspectives to provide a safe sterile environment.At the same time,patients,especially those in PE wards,were given special care and management to reduce their exposure to aspergillus spores.Conclusion:In this study,azole-resistant A fumigatus was isolated from flower pots in the hospital,indicating that patients admitted to the department were at risk of being infected with azole-resistant A.fumigatus,which provided certain experimental evidence for prohibiting flower cultivation in the hospital.This study demonstrates that TRESPERG typing is a promising genotyping method because of its high discriminatory power,lower cost and convenient for laboratory comparison.Through the literature study,we sorted out a set of the prevention advice of aspergillosis.The prevention of aspergillosis in the hospital is mainly from the management of patients at high-risk and the key is to avoid them to exposure to higher spores.