What’s new in invasive pulmonary aspergillosis in the critically ill

Excerpt

Invasive pulmonary aspergillosis (IPA) has been increasingly recognized as an emerging and understudied opportunistic infection in critically ill patients without classic host factors reflecting profound immunosuppression as defined by the European Organization for the Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG) [1, 2]. Impaired immune response following critical illness and particular underlying conditions put patients at risk of IPA [1]. Predisposing conditions frequently met in intensive care units (ICUs) include chronic obstructive pulmonary disease (COPD), corticosteroid (CS) use, decompensated liver disease, acute respiratory distress syndrome (ARDS), severe sepsis, post-sepsis immunoparalysis, and H1N1 virus infection (especially if CS prior to ICU admission) [1, 3‐5]. A recent large retrospective study among ICU patients without traditional risk factors for IPA reported that the most frequent underlying conditions were acute respiratory failure, acute renal failure, COPD, and septicemia/septic shock [3]. The real IPA incidence in ICU patients is difficult to estimate. Previously reported rates vary widely from 0.017 % to as high as 6.9 % [1, 3]. Despite the availability of novel potent antifungals, IPA continues to carry a dreadful prognosis in ICU patients with reported mortality rates of 46–95 %. The variability in incidence and fatality rates can be attributed to case-mix differences and the problematic diagnosis. Additionally, IPA is associated with considerable morbidity and healthcare costs [3]. For non-immunocompromised critically ill patients, an average length of hospital and ICU stay of 27 and 16 days, respectively, was reported, thereby contributing to a substantial cost burden [3]. …