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Critical Care
Published in: Critical Care 1/2015

Open Access 01-12-2015 | Research

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

Authors: 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, on behalf of the AspICU Study Investigators

Published in: Critical Care | Issue 1/2015

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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.
Appendix
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Literature
1.
Meersseman W, Van Wijngaerden E. Invasive aspergillosis in the ICU: an emerging disease. Intensive Care Med. 2007;33:1679–81.PubMed
2.
Auberger J, Lass-Flörl C, Ulmer H, Nogler-Semenitz E, Clausen J, Gunsilius E, et al. Significant alterations in the epidemiology and treatment outcome of invasive fungal infections in patients with hematological malignancies. Int J Hematol. 2008;88:508–15.PubMed
3.
Eriksson M, Lemström K, Suojaranta-Ylinen R, Martelius T, Harjula A, Sipponen J, et al. Control of early Aspergillus mortality after lung transplantation: outcome and risk factors. Transplant Proc. 2010;42:4459–64.PubMed
4.
Lugosi M, Alberti C, Zahar JR, Garrouste M, Lemiale V, Descorps-Desclère A, et al. Aspergillus in the lower respiratory tract of immunocompetent critically ill patients. J Infect. 2014;69:284–92.PubMed
5.
Meersseman W, Lagrou K, Maertens J, Wilmer A, Hermans G, Vanderschueren S, et al. Galactomannan in bronchoalveolar lavage fluid: a tool for diagnosing aspergillosis in intensive care unit patients. Am J Respir Crit Care Med. 2008;177:27–34.PubMed
6.
Khasawneh F, Mohamad T, Moughrabieh MK, Lai Z, Ager J, Soubani AO. Isolation of Aspergillus in critically ill patients: a potential marker of poor outcome. J Crit Care. 2006;21:322–7.PubMed
7.
Garnacho-Montero J, Amaya-Villar R, Ortiz-Leyba C, León C, Alvarez-Lerma F, Nolla-Salas J, et al. Isolation of Aspergillus spp. from the respiratory tract in critically ill patients: risk factors, clinical presentation and outcome. Crit Care. 2005;9:R191–9.PubMedPubMedCentral
8.
Vandewoude K, Blot S, Benoit D, Depuydt P, Vogelaers D, Colardyn F. Invasive aspergillosis in critically ill patients: analysis of risk factors for acquisition and mortality. Acta Clin Belg. 2004;59:251–7.PubMed
9.
De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46:1813–21.PubMed
10.
Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34:344–53.PubMed
11.
Petri MG, König J, Moecke HP, Gramm HJ, Barkow H, Kujath P, et al. Paul-Ehrlich Society for Chemotherapy, Divisions of Mycology and Pneumonia Research. Epidemiology of invasive mycosis in ICU patients: a prospective multicenter study in 435 non-neutropenic patients. Intensive Care Med. 1997;23:317–25.PubMed
12.
Blot S, Charles PE. Fungal sepsis in the ICU: are we doing better? Trends in incidence, diagnosis, and outcome. Minerva Anestesiol. 2013;79:1396–405.PubMed
13.
Montagna MT, Caggiano G, Lovero G, De Giglio O, Coretti C, Cuna T, et al. Epidemiology of invasive fungal infections in the intensive care unit: results of a multicenter Italian survey (AURORA Project). Infection. 2014;42:141–51.PubMed
14.
Meersseman W, Vandecasteele SJ, Wilmer A, Verbeken E, Peetermans WE, Van Wijngaerden E. Invasive aspergillosis in critically ill patients without malignancy. Am J Respir Crit Care Med. 2004;170:621–5.PubMed
15.
Dimopoulos G, Piagnerelli M, Berré J, Eddafali B, Salmon I, Vincent JL. Disseminated aspergillosis in intensive care unit patients: an autopsy study. J Chemother. 2003;15:71–5.PubMed
16.
Vandewoude KH, Blot SI, Depuydt P, Benoit D, Temmerman W, Colardyn F, et al. Clinical relevance of Aspergillus isolation from respiratory tract samples in critically ill patients. Crit Care. 2006;10:R31.PubMedPubMedCentral
17.
Levy H, Horak DA, Tegtmeier BR, Yokota SB, Forman SJ. The value of bronchoalveolar lavage and bronchial washings in the diagnosis of invasive pulmonary aspergillosis. Respir Med. 1992;86:243–8.PubMed
18.
Baddley JW, Stephens JM, Ji X, Gao X, Schlamm HT, Tarallo M. Aspergillosis in Intensive Care Unit (ICU) patients: epidemiology and economic outcomes. BMC Infect Dis. 2013;13:29.PubMedPubMedCentral
19.
Donati DY, Papazian L. Role of open-lung biopsy in acute respiratory distress syndrome. Curr Opin Crit Care. 2008;14:75–9.PubMed
20.
Koulenti D, Garnacho-Montero J, Blot S. Approach to invasive pulmonary aspergillosis in critically ill patients. Curr Opin Infect Dis. 2014;27:174–83.PubMed
21.
Koulenti D, Vogelaers D, Blot S. What’s new in invasive pulmonary aspergillosis in the critically ill? Intensive Care Med. 2014;40:723–6.PubMedPubMedCentral
22.
He H, Ding L, Chang S, Li F, Zhan Q. Value of consecutive galactomannan determinations for the diagnosis and prognosis of invasive pulmonary aspergillosis in critically ill chronic obstructive pulmonary disease. Med Mycol. 2011;49:345–51.PubMed
23.
Blot SI, Taccone FS, Van den Abeele AM, Bulpa P, Meersseman W, Brusselaers N, et al. A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients. Am J Respir Crit Care Med. 2012;186:56–64.PubMed
24.
25.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–29.PubMed
26.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. on behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22:707–10.PubMed
27.
Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818–24.PubMed
28.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31:1250–6.PubMed
29.
Ascioglu S, Rex JH, de Pauw B, Bennett JE, Bille J, Crokaert F, et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis. 2002;34:7–14.PubMed
30.
Barberan J, Alcazar B, Malmierca E. Garcia de la Llana F, Dorca J, del Castillo D, et al. Repeated Aspergillus isolation in respiratory samples from non-immunocompromised patients not selected based on clinical diagnoses: colonisation or infection? BMC Infect Dis. 2012;12:295.PubMedPubMedCentral
31.
Tortorano AM, Dho G, Prigitano A, Breda G, Grancini A, Emmi V, et al. Invasive fungal infections in the intensive care unit: a multicentre, prospective, observational study in Italy (2006–2008). Mycoses. 2012;55:73–9.PubMed
32.
Petri MG, König J, Moecke HP, Gramm HJ, Barkow H, Kujath P, et al. Epidemiology of invasive mycosis in ICU patients: a prospective multicenter study in 435 non-neutropenic patients. Intensive Care Med. 1997;23:317–25.PubMed
33.
Spapen H, Spapen J, Taccone FS, Meersseman W, Rello J, Dimopoulos G, et al. Cerebral aspergillosis in adult critically ill patients: a descriptive report of 10 patients from the AspICU cohort. Int J Antimicrob Agents. 2014;43:165–9.PubMed
34.
Baddley JW, Stroud TP, Salzman D, Pappas PG. Invasive mold infections in allogeneic bone marrow transplant recipients. Clin Infect Dis. 2001;32:1319–24.PubMed
35.
Baddley JW, Andes DR, Marr KA, Kontoyiannis DP, Alexander BD, Kauffman CA, et al. Factors associated with mortality in transplant patients with invasive aspergillosis. Clin Infect Dis. 2010;50:1559–67.PubMed
36.
Bouza E, Guinea J, Peláez T, Pérez-Molina J, Alcalá L, Muñoz P. Workload due to Aspergillus fumigatus and significance of the organism in the microbiology laboratory of a general hospital. J Clin Microbiol. 2005;43:2075–9.PubMedPubMedCentral
37.
Burghi G, Lemiale V, Seguin A, Lambert J, Lacroix C, Canet E, et al. Outcomes of mechanically ventilated hematology patients with invasive pulmonary aspergillosis. Intensive Care Med. 2011;37:1605–12.PubMed
38.
Bulpa PA, Dive AM, Garrino MG, Delos MA, Gonzalez MR, Evrard PA, et al. Chronic obstructive pulmonary disease patients with invasive pulmonary aspergillosis: benefits of intensive care? Intensive Care Med. 2001;27:59–67.PubMed
39.
Gustot T, Maillart E, Bocci M, Surin R, Trépo E, Degré D, et al. Invasive aspergillosis in patients with severe alcoholic hepatitis. J Hepatol. 2014;60:267–74.PubMed
40.
Guinea J, Torres-Narbona M, Gijón P, Muñoz P, Pozo F, Peláez T, et al. Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: incidence, risk factors, and outcome. Clin Microbiol Infect. 2010;16:870–7.PubMed
41.
Barberan J, Sanz F, Hernandez JL, Merlos S, Malmierca E, Garcia-Perez FJ, et al. Clinical features of invasive pulmonary aspergillosis vs. colonization in COPD patients distributed by GOLD stage. J Infect. 2012;65:447–52.PubMed
42.
Ader F, Nseir S, Le Berre R, Leroy S, Tillie-Leblond I, Marquette CH, et al. Invasive pulmonary aspergillosis in chronic obstructive pulmonary disease: an emerging fungal pathogen. Clin Microbiol Infect. 2005;11:427–9.PubMed
43.
Marr KA, Carter RA, Crippa F, Wald A, Corey L. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2002;34:909–17.PubMed
44.
Falcone M, Massetti AP, Russo A, Vullo V, Venditti M. Invasive aspergillosis in patients with liver disease. Med Mycol. 2011;49:406–13.PubMed
45.
Hartemink KJ, Paul MA, Spijkstra JJ, Girbes AR, Polderman KH. Immunoparalysis as a cause for invasive aspergillosis? Intensive Care Med. 2003;29:2068–71.PubMed
46.
Wauters J, Baar I, Meersseman P, Meersseman W, Dams K, De Paep R, et al. Invasive pulmonary aspergillosis is a frequent complication of critically ill H1N1 patients: a retrospective study. Intensive Care Med. 2012;38:1761–8.PubMedPubMedCentral
47.
Janssen JJ. Strack van Schijndel RJ, van der Poest Clement EH, Ossenkoppele GJ, Thijs LG. Huijgens PC Outcome of ICU treatment in invasive aspergillosis Intensive Care Med. 1996;22:1315–22.PubMed
48.
Kim A, Nicolau DP, Kuti JL. Hospital costs and outcomes among intravenous antifungal therapies for patients with invasive aspergillosis in the United States. Mycoses. 2011;54:e301–12.PubMed
49.
Vandewoude KH, Blot SI, Benoit D, Colardyn F, Vogelaers D. Invasive aspergillosis in critically ill patients: attributable mortality and excesses in length of ICU stay and ventilator dependence. J Hosp Infect. 2004;56:269–76.PubMed
50.
Robinett KS, Weiler B, Verceles AC. Invasive aspergillosis masquerading as catastrophic antiphospholipid syndrome. Am J Crit Care. 2013;22:448–51.PubMedPubMedCentral
51.
Winters B, Custer J, Galvagno Jr SM, Colantuoni E, Kapoor SG, Lee H, et al. Diagnostic errors in the intensive care unit: a systematic review of autopsy studies. BMJ Qual Saf. 2012;21:894–902.PubMed
52.
Mullins J, Harvey R, Seaton A. Sources and incidence of airborne Aspergillus fumigatus (Fres). Clin Allergy. 1976;6:209–17.PubMed
53.
Peláez T, Muñoz P, Guinea J, Valerio M, Giannella M, Klaassen CHW, et al. Outbreak of invasive aspergillosis after major heart surgery caused by spores in the air of the intensive care unit. Clin Infect Dis. 2012;54:e24–31.PubMed
Metadata
Title
Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes
Authors
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
on behalf of the AspICU Study Investigators
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2015
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-014-0722-7

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