Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes

Fabio Silvio Taccone, Anne-Marie Van den Abeele, Pierre Bulpa, Benoit Misset, Wouter Meersseman, Teresa Cardoso, José-Artur Paiva, Miguel Blasco-Navalpotro, Emmanuel De Laere, George Dimopoulos, Jordi Rello, Dirk Vogelaers, Stijn I Blot, AspICU Study Investigators, Miguel Blasco-Navalpotro, Stijn Blot, Nele Brusselaers, Pierre Bulpa, Teresa Cardoso, Pierre-Emmanuel Charles, Didier Clause, Patricia Courouble, Emmanuel De Laere, George Dimopoulos, Frédéric Forêt, Dan Li, Claude Martin, Shahram Mashayekhi, Wouter Meersseman, Benoit Misset, José Artur Paiva, Alessandro Pasqualotto, Marcos Pérez, Ratna Rao, Jordi Rello, Jessica Souto, Herbert Spapen, Fabio Silvio Taccone, Anne-Marie Van den Abeele, Koenraad Vandewoude, Dirk Vogelaers, Fabio Silvio Taccone, Anne-Marie Van den Abeele, Pierre Bulpa, Benoit Misset, Wouter Meersseman, Teresa Cardoso, José-Artur Paiva, Miguel Blasco-Navalpotro, Emmanuel De Laere, George Dimopoulos, Jordi Rello, Dirk Vogelaers, Stijn I Blot, AspICU Study Investigators, Miguel Blasco-Navalpotro, Stijn Blot, Nele Brusselaers, Pierre Bulpa, Teresa Cardoso, Pierre-Emmanuel Charles, Didier Clause, Patricia Courouble, Emmanuel De Laere, George Dimopoulos, Frédéric Forêt, Dan Li, Claude Martin, Shahram Mashayekhi, Wouter Meersseman, Benoit Misset, José Artur Paiva, Alessandro Pasqualotto, Marcos Pérez, Ratna Rao, Jordi Rello, Jessica Souto, Herbert Spapen, Fabio Silvio Taccone, Anne-Marie Van den Abeele, Koenraad Vandewoude, Dirk Vogelaers

Abstract

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 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.

Figures

Figure 1
Figure 1
Number of sites affected byAspergillusspp for the different diagnostic categories. Patients who had multiple sites positive for Aspergillus spp were counted more than once. CO, Colonization; PR, Proven; PT, Putative. Data are reported as number (%).
Figure 2
Figure 2
Survival curves for different diagnostic categories using the criteria of the clinical algorithm. The result of the log-rank analysis for survival distributions was P < 0.001 when putative or proven invasive aspergillosis (IA) was compared with colonization. The result of the log-rank analysis for survival distribution between putative and proven IA was P = 0.156. See Appendix 2 for clinical algorithm.

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