Clinical risk factors and bronchoscopic features of invasive aspergillosis in Intensive Care Unit patients (original) (raw)
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Internal and Emergency Medicine, 2021
Blot and colleagues have proposed putative invasive pulmonary aspergillosis (PIPA) definitions for troublesome diagnosis in suspected patients outside the classical criteria of immunosuppression. We retrospectively included in the study all admitted patients with an Aspergillus spp. positive culture within lower airway samples. Overall, Aspergillus spp. positivity in respiratory samples was 0.97 every 1000 hospital admissions (HA): 4.94 and 0.28/1000/HA, respectively, in intensive care units (ICUs) and medical wards (MW). 66.6% fulfilled PIPA criteria, and 33.4% were defined as colonized. 69.2% of PIPA diagnosis occurred in the ICU. Antifungal therapy was appropriate in 88.5% of subjects with PIPA and 37.5% of colonized, confirming the comparison between deads and lives. Patients with PIPA in the ICUs had more frequent COPD, sepsis or septic shock, acute kidney injury (AKI), needed more surgery, mechanical ventilation (MV), vasopressors, hemodialysis, blood or platelets transfusions...
Critical Care, 2015
Introduction Invasive aspergillosis (IA) is a fungal infection that particularly affects immunocompromised hosts. Recently, several studies have indicated a high incidence of IA in intensive care unit (ICU) patients. However, few data are available on the epidemiology and outcome of patients with IA in this setting. Methods An observational study including all patients with a positive Aspergillus culture during ICU stay was performed in 30 ICUs in 8 countries. Cases were classified as proven IA, putative IA or Aspergillus colonization according to recently validated criteria. Demographic, microbiologic and diagnostic data were collected. Outcome was recorded 12 weeks after Aspergillus isolation. Results A total of 563 patients were included, of whom 266 were colonized (47%), 203 had putative IA (36%) and 94 had proven IA (17%). The lung was the most frequent site of infection (94%), and Aspergillus fumigatus the most commonly isolated species (92%). Patients with IA had higher incid...
Invasive Aspergillosis in the Intensive Care Unit
Clinical Infectious Diseases, 2007
Data regarding the incidence of invasive aspergillosis (IA) in the intensive care unit (ICU) are scarce, and the incidence varies. An incidence of 5.8% in a medical ICU has been reported. The majority of patients did not have a hematological malignancy, and conditions such as chronic obstructive pulmonary disease and liver failure became recognized as risk factors. Diagnosis of IA remains difficult. Mechanical ventilation makes it difficult to interpret clinical signs, and radiological diagnoses are clouded by underlying lung pathologies. The significance of a positive respiratory culture result is greatly uncertain, because cultures of respiratory specimens have low sensitivity (50%) and specificity (20%-70%, depending on whether the patient is immunocompromised). The use of serologic markers has never been validated in an ICU population. Limited experience with the detection of galactomannan in bronchoalveolar lavage fluid specimens has yielded promising results. Because of a delay in the diagnosis of IA, the mortality rate exceeds 50%. Recently, our therapeutic armamentarium against IA has improved. Data concerning the safety and efficacy of new antifungal agents in the ICU setting, however, are lacking.
Aspergillosis in the ICU – The new 21st century problem?
Medical Mycology, 2006
Invasive pulmonary aspergillosis (IPA) is a serious opportunistic infection mainly affecting seriously immunocompromised patients. The major risk factor is prolonged granulocytopenia. Most literature on the epidemiology and clinical impact of Aspergillus spp. infections concern patients with hematological malignancies, cancer, stem cell transplantation and solid organ transplant patients. However, evidence from recent literature indicates that Aspergillus spp. may cause invasive disease in other categories of patients without apparent immunodeficiency, including patients in intensive care units (ICUs). Clinical diagnosis of IPA in nonimmunocompromised patients is difficult. Standardized diagnostic definitions, developed by the European Organization for the Research and Treatment of Cancer/Mycosis Study Group for research purposes in patients with cancer and in recipients of haematopoietic stem cell transplants, are not feasible for patient categories with an intermediate to low probability for acquiring IPA. In routine clinical practice, most Aspergillus isolates from non-sterile body sites do not represent disease. Invasive diagnostic procedures are often not feasible in patients with severe respiratory insufficiency and critical illness. The presence of systemic risk factors, or underlying predisposing lung disease or general debilitation, may enhance the clinical relevance of a positive culture. The finding of an Aspergillus spp. positive respiratory specimen in an ICU patient should not be discarded; preemptive antifungal treatment should be considered, while attempting to substantiate the diagnosis.
Critical Care, 2015
Recently, several studies have indicated a high incidence of IA in intensive care unit (ICU) patients. However, few data are available on the epidemiology and outcome of patients with IA in this setting. Methods: An observational study including all patients with a positive Aspergillus culture during ICU stay was performed in 30 ICUs in 8 countries. Cases were classified as proven IA, putative IA or Aspergillus colonization according to recently validated criteria. Demographic, microbiologic and diagnostic data were collected. Outcome was recorded 12 weeks after Aspergillus isolation. Results: A total of 563 patients were included, of whom 266 were colonized (47%), 203 had putative IA (36%) and 94 had proven IA (17%). The lung was the most frequent site of infection (94%), and Aspergillus fumigatus the most commonly isolated species (92%). Patients with IA had higher incidences of cancer and organ transplantation than those with colonization. Compared with other patients, they were more frequently diagnosed with sepsis on ICU admission and more frequently received vasopressors and renal replacement therapy (RRT) during the ICU stay. Mortality was 38% among colonized patients, 67% in those with putative IA and 79% in those with proven IA (P < 0.001). Independent risk factors for death among patients with IA included older age, history of bone marrow transplantation, and mechanical ventilation, RRT and higher Sequential Organ Failure Assessment score at diagnosis. Conclusions: IA among critically ill patients is associated with high mortality. Patients diagnosed with proven or putative IA had greater severity of illness and more frequently needed organ support than those with Aspergillus spp colonization.
Journal of Hospital Infection
Invasive aspergillosis is a rare disease in intensive care unit (ICU) patients and carries a poor prognosis. The aim of the present study was to determine the attributable mortality due to invasive aspergillosis in critically ill patients. In a retrospective, matched cohort study (July 1997-December 1999), 37 ICU patients with invasive aspergillosis were identified together with 74 control patients. Matching of control (1:2) patients was based on the acute physiology and chronic health evaluation (APACHE) II classification: an equal APACHE II score (+/-1 point) and diagnostic category. This matching procedure results in an equal expected in-hospital mortality for cases and controls. Additionally, control patients were required to have an ICU stay equivalent to or longer than the case before the first culture positive for Aspergillus spp. Patients with invasive aspergillosis were more likely to experience acute renal failure (43.2% versus 20.5%; P = 0.020). They also had a longer ICU...
Critical care (London, England), 2006
The diagnosis of invasive pulmonary aspergillosis, according to the criteria as defined by the European Organisation for the Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG), is difficult to establish in critically ill patients. The aim of this study is to address the clinical significance of isolation of Aspergillus spp. from lower respiratory tract samples in critically ill patients on the basis of medical and radiological files using an adapted diagnostic algorithm to discriminate proven and probable invasive pulmonary aspergillosis from Aspergillus colonisation. Using a historical cohort (January 1997 to December 2003), all critically ill patients with respiratory tract samples positive for Aspergillus were studied. In comparison to the EORTC/MSG criteria, a different appreciation was given to radiological features and microbiological data, including semiquantitative cultures and direct microscopic examination of broncho-alveolar lavage samples. Over a 7 year per...
Polish archives of internal medicine, 2021
Patients and methods The study involved an analysis of the results of microbiological tests as well as demographic and clinical data of patients with COVID-19 pneumonia treated in the ICU of the Heliodor Swiecicki University Hospital in Poznan, Poland in the first month of its operation (from November 10 to December 10, 2020). During that time, a total of 19 patients were hospitalized in the ward and aspergillosis was confirmed in 7 individuals (all male). The microbiological tests were conducted on bronchoalveolar lavage samples collected from patients with severe respiratory tract infections caused by SARS-CoV-2. The samples were collected during bronchial fibroscopy or as tracheal aspirate. Standard microbiological growth media for routine diagnostics of bacteria and fungi were used to analyze the material (for fungi, Sabouraud agar with chloramphenicol and gentamicin). The material tested for fungi was cultured longer than the standard 48 hours, that is, up to the fourteenth day of its collection. The mean age of the patients was 64 years (range, 44-73 years). The following factors increasing the risk of fungal infections were found: cancer (1 patient), chronic obstructive
Clinical Diagnosis of Invasive Pulmonary Aspergillosis in a Non-Neutropenic Critically Ill Patient
Respiratory Care, 2013
Real life diagnosis of invasive pulmonary aspergillosis in a non neutropenic critically ill patient Introduction : Invasive Pulmonary Aspergillosis (IPA) is a life threatening fungal infection that predominantly affects severely immunocompromised patients, particulary those with prolonged neutropenia or organ transplantation. 1 Definitions have been developed that facilitate the diagnosis of IPA in immunocompromised patients with cancer or hematologic malignancy. 2 More recently, publications explored IPA in non-immunocompromised patients in intensive care units (ICU). 3,4 In this specific setting, diagnosis of IPA is challenging for several reasons: it is a relatively uncommon condition, clinical presentation may be unspecific and mimick ventilator-associated pneumonia, specific radiological and microbiological findings may be delayed. To highlight the difficulties of IPA diagnosis in the ICU, we present the case of an 82-year-old ICU patient without immunosuppression affected by possible IPA. Case presentation An 82-year-old woman was referred to our intensive care unit (ICU) for septic shock and acute kidney injury due to acute peritonitis. Before the onset of the symptoms, she was in good health without any chronic medication and her past medical history was significant only for hypertension. She was a non-smoker. She underwent surgery and supportive care was initiated with broad spectrum antibiotics, vasopressor support, mechanical ventilation and intravenous hydrocortisone (200mg per day) treatment. Initial evolution was favorable, except RESPIRATORY CARE Paper in Press.