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

• Published in: Critical care (London, England) Vol. 19; no. 1; p. 7
• Main Authors: Taccone, Fabio Silvio, Van den Abeele, Anne-Marie, Bulpa, Pierre, Misset, Benoit, Meersseman, Wouter, Cardoso, Teresa, Paiva, José-Artur, Blasco-Navalpotro, Miguel, De Laere, Emmanuel, Dimopoulos, George, Rello, Jordi, Vogelaers, Dirk, Blot, Stijn I
• Format: Journal Article Web Resource
• Language: English
• Published: England BioMed Central Ltd 2015; BioMed Central
• Subjects: Adult; Aged; Anesthesia & intensive care; Anesthésie & soins intensifs; Antibiotics; Antifungal agents; Aspergillosis; Biopsy; Bone marrow; Care and treatment; Chronic obstructive pulmonary disease; Comorbidity; Critical care; Critical Illness; Diagnosis; Epidemiology; Ethics; Female; Fungal infections; Hospital costs; Human health sciences; Humans; Immunocompromised Host; Incidence; Infection; Intensive care; Intensive Care Units; Male; Medical research; Medicin och hälsovetenskap; Medicine, Experimental; Middle Aged; Mortality; Opportunistic Infections - diagnosis; Opportunistic Infections - mortality; Opportunistic Infections/diagnosis/mortality; Patient outcomes; Pulmonary Aspergillosis - complications; Pulmonary Aspergillosis - diagnosis; Pulmonary Aspergillosis - mortality; Pulmonary Aspergillosis/complications/diagnosis/mortality; Respiration, Artificial - adverse effects; Risk Factors; Sciences de la santé humaine; Transplantation; Transplantation of organs, tissues, etc; United Kingdom; United Kingdom; Belgium; Spain
• ISSN: 1364-8535; 1466-609X; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-014-0722-7

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.
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.
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.
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.