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Aspergillosis in critically ill patients: Results from a large multicenter cohort

par Taccone, Fabio ;Bulpa, Pierre;Van den Abeele, Anne-Marie;Dimopoulos, George;Rello, Jordi;Misset, Benoit;Paiva, José A;Vandewoude, K;Vogelaers, Dirk;Blot, Stijn
Référence European Society of Intensive Care Medecine Annual Congress(XXVI: 5-9 October 2013: Paris), 26th ESICM Annual Congress
Publication Publié, 2013-10

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Résumé :

INTRODUCTION. Invasive aspergillosis (IA) is a fungal infection particularly affecting immunocompromized hosts. Recently, several reports indicate an important occurrence rate of IA in ICU patients; however few data are available on epidemiology and outcome of patients with IA in this setting.OBJECTIVES. We report data from the AspICU project, a multicenter (n=30) observational study including all patients with a positive Aspergillus culture, from November 2006 to January 2011. IA was defined according to a clinical and validated algorithm that discriminates Aspergillus colonization from putative or proven IA in ICU patients (1).METHODS. We report data from the AspICU project, a multicenter (n=30) observational study including all patients with a positive Aspergillus culture, from November 2006 to January 2011. IA was defined according to a clinical and validated algorithm that discriminates Aspergillus colonization from putative or proven IA in ICU patients (1).RESULTS. A total of 563 patients were included. Of these, 296 cases (46.9%) were classified as IA (of which 93 proven and 203 putative IA). The lung was the most frequent site of infection (94%) and Aspergillus fumigatus the most common isolated species (92%). The median APACHE II score at admission was 23 [17-28] and the median SOFA score at time of diagnosis of IA was 8 [4-12]. Overall 12-week mortality was 54%. Patients with proven and putative IA had more frequently cancer and organ transplantation than those with colonization. Also, both groups were more frequently diagnosed with sepsis on ICU admission and received more frequently vasopressors and renal replacement therapy (RRT) during ICU stay than others. Particularly, in patients with proven IA, COPD was less frequently observed than in putative IA; in addition, proven IA patients were more frequently admitted for medical reasons, had higher incidence of ARDS on ICU admission and higher SOFA score on IA diagnosis than putative IA. Finally, RRT and antifungal therapy were more commonly used among patients with proven IA. Calculation of proportion of survival at 100 days yielded that the patients with putative and proven IA had significantly lower survival than those in the colonization group (log rank p < 0.001), even after adjustment for several confounders. Interestingly, among those patients with proven and putative IA, the use of antifungal therapy was associated with an increased survival when compared to untreated patients.CONCLUSIONS. IA among critically ill patients is associated with high mortality. Patients diagnosed with both proven and putative IA showed higher severity of illness and needed more frequently vasopressors and RRT than those colonized by Aspergillus spp. Prompt and adequate therapy may influence mortality among patients with proven and putative IA.REFERENCE(S). (1) Vandewoude K, et al. Crit Care 2006.