Outcome of ICU treatment in invasive aspergillosis (original) (raw)

Abstract

Objective

To assess the outcome of intensive care treatment in invasive aspergillosis.

Design

Retrospective study.

Setting

University Hospital, Medical Intensive Care Unit (ICU).

Patients

Twenty-five patients with invasive aspergillosis who were admitted to the medical ICU in a 5 1/2 year period. Twenty-two had received high-dose chemotherapy for (mainly hematologic) malignancies, one had been treated with cyclosporine and prednisolone for systemic lupus erythematosus, one with high-dose methylprednisolone for polyarteritis nodosa and one had an ARDS after near-drowning.

Measurements and results

The medical records were reviewed for patient and disease characteristics, outcome, reasons for admission to the ICU, supportive care and antifungal therapy as well as for the results of cultures and autopsy. Out of 25 patients, a definite ante mortem diagnosis could be established in seven. When autopsied patients were included, a total of 15 suffered from proven invasive aspergillosis. Although standard antifungal treatment and maximal available supportive care were given, 23 of 25 patients (92%) died after a mean of 15 (1–51) days in the ICU. Both patients who recovered had received high-dose chemotherapy for hematologic malignancy and showed bone marrow recovery and/or had a localized pulmonary infection.

Conclusions

In patients with highly suspected or proven invasive aspergillosis, admission to an ICU and mechanical ventilation should be considered in cases of localized infection and obvious signs of hematologic recovery. In most other circumstances ICU admission for mechanical ventilation does not seem to improve survival.

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References

  1. Denning DW, Stevens DA (1990) Antifungal and surgical treatment of invasive aspergillosis: review of 2121 published cases. Rev Infect Dis 12: 1147–1201
    PubMed Google Scholar
  2. Karam GH, Griffin FM (1986) Invasive pulmonary aspergillosis in nonimmunosuppressed, non-neutropenic hosts. Rev Infect Dis 8: 357–363
    PubMed Google Scholar
  3. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Apache II: a severity of disease classification system. Crit Care Med 13: 818–829
    PubMed Google Scholar
  4. Fisher BD, Armstrong D, Yu B, Gold JWM (1981) Invasive aspergillosis. Progress in early diagnosis and treatment. Am J Med 71: 571–577
    PubMed Google Scholar
  5. Schuster DP, Marion JM (1983) Precedents of meaningful recovery during treatment in a medical intensive care unit. Outcome in patients with hematologic malignancy. Am J Med 75: 402–408
    PubMed Google Scholar
  6. Estopa R, Marti AT, Kastanos N, Rives A, Agusti-Vidal A, Rozman C (1984) Acute respiratory failure in severe hematologic disorders. Crit Care Med 12: 26–28
    PubMed Google Scholar
  7. Ewer MS, Ali MK, Atta MS, Morice RC, Balakrishnan PV (1986) Outcome of lung cancer patients requiring mechanical ventilation for pulmonary failure. JAMA 256: 3364–3366
    PubMed Google Scholar
  8. Saugier-Veber P, Devergie A, Sulahian A, Ribaud P, Traore F, Bourdeau-Esperou H et al. (1993) Epidemiology and diagnosis of invasive pulmonary aspergillosis in bone marrow transplant patients: results of a 5-year retrospective study. Bone Marrow Transplant 12: 121–124
    PubMed Google Scholar
  9. Peters SG, Meadows JA, Gracey DR (1988) Outcome of respiratory failure in hematologic malignancy. Chest 94/1: 99–102
    Google Scholar
  10. Crawford SW, Petersen FB (1992) Long-term survival from respiratory failure after marrow transplantation for malignancy. Am Rev Respir Dis 145: 510–514
    PubMed Google Scholar
  11. Poe RH, Wahl GW, Qazi R, Kallay MC, Utell MJ, Morrow GR (1986) Predictors of mortality in the immunocompromised patient with pulmonary infiltrates. Arch Intern Med 146: 1304–1308
    PubMed Google Scholar
  12. Crawford SW, Schwartz DA, Petersen FB, Clark JC (1988) Risk factors of mechanical ventilation after marrow transplantation. Am Rev Respir Dis 137: 682–687
    PubMed Google Scholar
  13. Faber-Langedoen K, Caplan AL, McGlave PB (1993) Survival of adult bone marrow transplant patients receiving mechanical ventilation: a case for restricted use. Bone Marrow Transplant 12: 501–507
    PubMed Google Scholar
  14. Lloyd-Thomas AR, Wright I, Lister TA, Hinds CJ (1988) Prognosis of patients receiving intensive care for life-threatening medical complications of haematological malignancy. BMJ 296: 1025–1029
    PubMed Google Scholar
  15. Yau E, Rohatiner AZS, Lister TA, Hinds CJ (1991) Long term prognosis and quality of life following intensive care for life-threatening complications of haematologic malignancy. Br J Cancer 64: 938–942
    PubMed Google Scholar
  16. Afessa B, Tefferi A, Hoagland HC, Letendre L, Peters SG (1992) Outcome of recipients of bone marrow transplants who require intensive care unit support. Mayo Clin Proc 67: 117–122
    PubMed Google Scholar
  17. Gillespie DJ, Marsh HMM, Divertie MB, Meadows JA III (1986) Clinical outcome of respiratory failure in patients requiring prolonged (>24 hours) mechanical ventilation. Chest 90/3: 364–369
    Google Scholar
  18. Denardo SJ, Oye RK, Bellamy PE (1989) Efficacy of intensive care for bone marrow transplant patients with respiratory failure. Crit Care Med 17: 4–6
    PubMed Google Scholar
  19. McCabe RE, Brooks RG, Mark JBD, Remington JS (1985) Open lung biopsy in patients with acute leukemia. Am J Med 78: 609–616
    PubMed Google Scholar
  20. Yu VL, Muder RR, Poorsattar A (1986) Significance of isolation of Aspergillus from the respiratory tract in diagnosis of invasive pulmonary aspergillosis. Results from a three-year prospective study. Am J Med 81: 249–254
    PubMed Google Scholar
  21. Nalesnik MA, Myerowitz, Jenkins R, Lenkey J, Herbert D (1980) Significance of Aspergillus species isolated from respiratory secretions in the diagnosis of invasive pulmonary aspergillosis. J Clin Microbiol 11: 370–376
    PubMed Google Scholar
  22. Albelda SM, Talbot GH, Gerson SL, Miller WT, Cassileth PA (1984) Role of fiberoptic bronchoscopy in the diagnosis of invasive pulmonary aspergillosis in patients with acute leukemia. Am J Med 76: 1027–1034
    PubMed Google Scholar
  23. Stover DE, Zaman MB, Hajdu SI, Lange M, Gold J, Armstrong D (1984) Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host. Ann Intern Med 101: 1–7
    PubMed Google Scholar
  24. Tang CM, Holden DW, Aufavre-Brown A, Cohen J (1993) The detection of Aspergillus spp. by the polymerase chain reaction and its evaluation in bronchoalveolar lavage fluid. Am Rev Respir Dis 148: 1313–1317
    PubMed Google Scholar
  25. Schulze-Berge A, Sonntag H-G, Kappe R (1994) Evaluation of seven commercially available serodiagnostic tests for invasive aspergillosis. J Infect 28 (Suppl 1): 57–58
    Google Scholar
  26. Denning DW, Tucker RM, Hanson LH, Stevens DA (1989) Treatment of invasive aspergillosis with itraconazole. Am J Med 86: 791–800
    PubMed Google Scholar
  27. Denning DW (1994) Treatment of invasive aspergillosis. J Infect 28 (Suppl 1): 25–33
    Google Scholar
  28. NIAID Mycoses Study Group (1994) Multicenter trial of oral itraconazole therapy for invasive aspergillosis. Am J Med 97: 135–144
    Google Scholar
  29. Hay RJ (1994) Liposomal amphotericin B, AmBisome. J Infect 28 (Suppl 1): 35–43
    PubMed Google Scholar
  30. Gerson SL, Talbot GH, Hurwitz S, Strom BL, Lusk EJ, Cassileth PA (1984) Prolonged granulocytopenia: the major risk factor for invasive pulmonary aspergillosis in patients with acute leukemia. Ann Int Med 100: 345–351
    PubMed Google Scholar
  31. Working party of the British Society for Antimicrobial Chemotherapy (1993) Chemoprophylaxis for candidosis and aspergillosis in neutropenia and transplantation: a review and recommendations. J Antimicrob Chemother 32: 5–21
    Google Scholar

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Author notes

  1. J. J. W. M. Janssen
    Present address: Department of Internal Medicine, Academisch Ziekenhuis Vrije Universiteit, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands

Authors and Affiliations

  1. Medical Intensive Care Unit, Academisch Ziekenhuis Vrije Universiteit, 1007 MB, Amsterdam, The Netherlands
    J. J. W. M. Janssen, R. J. M. Strack van Schijndel, E. H. van der Poest Clement & L. G. Thijs
  2. Department of Hematology, Academisch, Ziekenhuis Vrije Universiteit, 1007 MB, Amsterdam, The Netherlands
    G. J. Ossenkoppele & P. C. Huijgens

Authors

  1. J. J. W. M. Janssen
  2. R. J. M. Strack van Schijndel
  3. E. H. van der Poest Clement
  4. G. J. Ossenkoppele
  5. L. G. Thijs
  6. P. C. Huijgens

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Janssen, J.J.W.M., Strack van Schijndel, R.J.M., van der Poest Clement, E.H. et al. Outcome of ICU treatment in invasive aspergillosis.Intensive Care Med 22, 1315–1322 (1996). https://doi.org/10.1007/BF01709544

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