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Critical Care
Published in: Critical Care 3/2005

Open Access 01-06-2005 | Research

Isolation of Aspergillus spp. from the respiratory tract in critically ill patients: risk factors, clinical presentation and outcome

Authors: José Garnacho-Montero, Rosario Amaya-Villar, Carlos Ortiz-Leyba, Cristóbal León, Francisco Álvarez-Lerma, Juan Nolla-Salas, José R Iruretagoyena, Fernando Barcenilla

Published in: Critical Care | Issue 3/2005

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Abstract

Introduction

Our aims were to assess risk factors, clinical features, management and outcomes in critically ill patients in whom Aspergillus spp. were isolated from respiratory secretions, using a database from a study designed to assess fungal infections.

Methods

A multicentre prospective study was conducted over a 9-month period in 73 intensive care units (ICUs) and included patients with an ICU stay longer than 7 days. Tracheal aspirate and urine samples, and oropharyngeal and gastric swabs were collected and cultured each week. On admission to the ICU and at the initiation of antifungal therapy, the severity of illness was evaluated using the Acute Physiology and Chronic Health Evaluation II score. Retrospectively, isolation of Aspergillus spp. was considered to reflect colonization if the patient did not fulfil criteria for pneumonia, and infection if the patient met criteria for pulmonary infection and if the clinician in charge considered the isolation to be clinically valuable. Risk factors, antifungal use and duration of therapy were noted.

Results

Out of a total of 1756 patients, Aspergillus spp. were recovered in 36. Treatment with steroids (odds ratio = 4.5) and chronic obstructive pulmonary disease (odds ratio = 2.9) were significantly associated with Aspergillus spp. isolation in multivariate analysis. In 14 patients isolation of Aspergillus spp. was interpreted as colonization, in 20 it was interpreted as invasive aspergillosis, and two cases were not classified. The mortality rates were 50% in the colonization group and 80% in the invasive infection group. Autopsy was performed in five patients with clinically suspected infection and confirmed the diagnosis in all of these cases.

Conclusion

In critically ill patients, treatment should be considered if features of pulmonary infection are present and Aspergillus spp. are isolated from respiratory secretions.
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Metadata
Title
Isolation of Aspergillus spp. from the respiratory tract in critically ill patients: risk factors, clinical presentation and outcome
Authors
José Garnacho-Montero
Rosario Amaya-Villar
Carlos Ortiz-Leyba
Cristóbal León
Francisco Álvarez-Lerma
Juan Nolla-Salas
José R Iruretagoyena
Fernando Barcenilla
Publication date
01-06-2005
Publisher
BioMed Central
Published in
Critical Care / Issue 3/2005
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc3488

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