P-420. Epidemiology of Patients with Laboratory-confirmed Aspergillus species in a Singaporean Hospital

Background

Aspergillus species is an opportunistic mould associated with serious complications, healthcare costs and mortality, especially in immunocompromised patients. WHO has declared Aspergillus fumigatus as a “critical pathogen”. This study aims to report clinical epidemiology of patients with Aspergillus species in Singapore General Hospital (SGH), an acute-care hospital.Table 1:Demographic and clinical characteristics of patients

Methods

Inpatients with laboratory-confirmed Aspergillus species were included in this retrospective, observational study between January 2018 and April 2024. For patients with > 1 positive cultures, first positive culture was used to describe clinical characteristics. Comorbidities were identified using ICD-10AM codes. Immunocompromised patients were those under haematology-oncology at time of specimen collection, received immunosuppressants within preceding 90 days and/or were neutropenic (count < 1x109/L) within 30 days preceding specimen collection. Trends were reported as monthly incident rates (IR) per 10,000 patient-days.Table 2:Breakdown of microbiology cultures

Results

The mean IR was 1.2 per 10,000 patient days (n=399). Median patient age was 67 years. 151 of 399 (38%) patients tested positive on a specimen taken ≥ 7 days after admission. 172 (43%) patients were immunocompromised. 213 (53%) patients had non-pneumonia respiratory illnesses, 211 (53%) had pneumonia and 201 (50%) had acute/chronic kidney disease. 79 (20%) patients were admitted under haematology-oncology and 53 (14%) had haematological malignancies. 151 (38%) patients received Aspergillus targeted anti-fungal treatment within ±7 days of positive result (surrogate for infections). Crude mortality was 29% (n=115) of whom 98 (85%) patients died within 30 days and 112 (97%) patients died within 90 days of positive specimen. Median duration between specimen collection and mortality was 11.7 days. Pneumonia was the most common cause of death (51%). 187 (47%) patients had positive Aspergillus species cultured from lower respiratory specimens. The common species was Aspergillus fumigatus complex (45%). No outbreaks were identified during this period.Table 3:Breakdown by Aspergillus species isolated

Conclusion

Aspergillus species causes significant morbidity and mortality in hospitalized patients, including non-immunocompromised. Hence hospital-wide surveillance should be implemented.

Trend of monthly incidence rates of laboratory-confirmed healthcare-associated Aspergillus patients

Disclosures

Moi Lin Ling, FRCPA, Solventum: Honoraria|Solventum: Educational grant for APSIC projects